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Massobrio R, Novara L, Mancarella M, Pace L, Giorgi M, Pascotto M, Campigotto B, Fuso L, Sgro LG, Bounous VE, Ferrero A. Nodal staging in high and high-intermediate risk endometrial cancer surgery: Which role in the molecular classification era? J Gynecol Obstet Hum Reprod 2024; 53:102787. [PMID: 38626819 DOI: 10.1016/j.jogoh.2024.102787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 04/10/2024] [Accepted: 04/13/2024] [Indexed: 09/02/2024]
Abstract
OBJECTIVES Nodal staging contributes to risk group definition and the indication to adjuvant treatment in endometrial cancer (EC) patients. However, the role of nodal assessment evolved and requires redefinition. Primary outcome of the study was to assess the impact of surgical nodal staging in defining high-risk (HR) EC. Secondary outcome was to evaluate the contribution of nodal assessment to the decision for adjuvant treatment in both high-risk and high-intermediate risk (HIR) patients submitted to surgery. METHODS Clinical stage I-II EC patients with postoperative diagnosis of HR and HIR disease were included. The contribution of nodal staging in prognostic groups allocation was assessed by reviewing HR patients to identify those without any other feature of such class (non-endometrioid histology, p53abn immunohistochemistry, post-operative T3-T4 disease) and HIR cases to assess how nodal staging affected adjuvant treatment indication. Descriptive statistics were conducted to describe the two populations. RESULTS Fifty-seven patients were included, 46 with HR and 11 with HIR disease. Chemotherapy and external-beam radiotherapy (EBRT) were proposed in 40 HR patients. Considering histology, immunohistochemical profile and FIGO stage, high risk classification was exclusively relied on nodal involvement in 2/46 cases (4.3 %). Omitting retroperitoneal staging, one of them would have been classified in the intermediate risk group and the other as HIR: without nodal staging, chemotherapy and EBRT would have been omitted in 1/40 (2.5 %) case. Among HIR patients, chemotherapy was proposed in 7/11 cases and EBRT in all cases. Adjuvant chemotherapy was indicated in 5/6 (83.3 %) and omitted in 1/6 (16.7 %) pN0 patient (stage Ib G2, substantial LVSI). In HIRpN0 patients, omitting nodal staging could have changed adjuvant treatment indication in 1/6 (16.7 %) case. In HIRpNx patients, adjuvant chemotherapy was omitted in one patient (stage II, grade 2 and LVSI negative): nodal staging unavailability might have changed indication to chemotherapy in 1/5 (20 %) case, without changing indication to EBRT. Unavailable nodal staging could globally be related to omission of chemotherapy in 2/57 (3.5 %) patients and of EBRT in 1/57 (1.8 %) patient. CONCLUSIONS In this series, nodal staging had limited impact on definition of HR class and on the choice of adjuvant treatment in HR and HIR EC patients.
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Affiliation(s)
- Roberta Massobrio
- Academic Division of Gynecology and Obstetrics, University of Torino, Mauriziano Hospital, 10128 Torino, Italy.
| | - Lorenzo Novara
- Academic Division of Gynecology and Obstetrics, University of Torino, Mauriziano Hospital, 10128 Torino, Italy
| | - Matteo Mancarella
- Academic Division of Gynecology and Obstetrics, University of Torino, Mauriziano Hospital, 10128 Torino, Italy
| | - Luca Pace
- Academic Division of Gynecology and Obstetrics, University of Torino, Mauriziano Hospital, 10128 Torino, Italy
| | - Margherita Giorgi
- Academic Division of Gynecology and Obstetrics, University of Torino, Mauriziano Hospital, 10128 Torino, Italy
| | - Maria Pascotto
- Academic Division of Gynecology and Obstetrics, University of Torino, Mauriziano Hospital, 10128 Torino, Italy
| | - Beatrice Campigotto
- Academic Division of Gynecology and Obstetrics, University of Torino, Mauriziano Hospital, 10128 Torino, Italy
| | - Luca Fuso
- Academic Division of Gynecology and Obstetrics, University of Torino, Mauriziano Hospital, 10128 Torino, Italy
| | - Luca Giuseppe Sgro
- Academic Division of Gynecology and Obstetrics, University of Torino, Mauriziano Hospital, 10128 Torino, Italy
| | | | - Annamaria Ferrero
- Academic Division of Gynecology and Obstetrics, University of Torino, Mauriziano Hospital, 10128 Torino, Italy
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Jaafar E, Gaultier V, Wohrer H, Estevez JP, Gonthier C, Koskas M. Impact of sentinel lymph node mapping on survival in patients with high-risk endometrial cancer in the early stage: A matched cohort study. Int J Gynaecol Obstet 2024; 165:677-684. [PMID: 38226675 DOI: 10.1002/ijgo.15315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 12/06/2023] [Indexed: 01/17/2024]
Abstract
OBJECTIVE The aim of this study was to compare patient survival using sentinel lymph node (SLN) procedure and pelvic lymphadenectomy for stating early-stage high risk endometrial cancer. METHODS Patients who underwent surgery for early-stage high risk endometrial cancer between 2010 and 2017 were extracted from the incidence registry of the SEER program. We identified patients who underwent SLN mapping. Patients who initially underwent pelvic lymphadenectomy were selected as the comparison group. One-to-one matching was performed according to age, ethnicity, histology, extension and grade. The primary outcome was disease-specific survival. The secondary outcome was overall survival. RESULTS A total of 326 patients who underwent SLN mapping and 326 who underwent pelvic lymphadenectomy initially were included in the study. The three-year analysis did not find a significant difference between the SLN and lymphadenectomy groups on disease-specific survival probability (88.2% vs 82.7, P = 0.07) and on overall survival probability (82.7% vs 78.2%, P = 0.57). Patients who underwent SLN mapping had a lower mean number of lymph nodes removed (mean 3 vs 16, P < 0.001) and there was a higher rate of patients with positive pelvic lymph nodes (18% vs 14%, P = 0.04). Following adjustment for confounding factors, disease-specific survival did not vary according to the lymph node intervention performed (P = 0.056), but the SLN group had better overall survival than those in the lymphadenectomy group (P = 0.047). CONCLUSION The SLN technique was not associated with poorer disease-specific survival than pelvic lymphadenectomy even after adjustment. These results suggest that SLN is an acceptable and safe procedure in surgical staging for early-stage high-risk endometrial cancer.
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Affiliation(s)
- Eya Jaafar
- Gynecological Department, Bichat Hospital, Paris Diderot University, Paris, France
| | - Victor Gaultier
- Gynecological Department, Bichat Hospital, Paris Diderot University, Paris, France
- Gynecological Department, University Paris Cité, Paris, France
| | - Henri Wohrer
- Gynecological Department, Bichat Hospital, Paris Diderot University, Paris, France
- Gynecological Department, University Paris Cité, Paris, France
| | - Juan Pablo Estevez
- Gynecological Department, Bichat Hospital, Paris Diderot University, Paris, France
| | - Clementine Gonthier
- Gynecological Department, Bichat Hospital, Paris Diderot University, Paris, France
| | - Martin Koskas
- Gynecological Department, Bichat Hospital, Paris Diderot University, Paris, France
- Gynecological Department, University Paris Cité, Paris, France
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Shi XL, Chen S, Guo GD, Yang YL, Tong KM, Cao W, Huang LL, Zhang YR. Precise lymph node biopsy for endometrial cancer confined to the uterus: Analysis of 43 clinical cases. Taiwan J Obstet Gynecol 2024; 63:369-374. [PMID: 38802200 DOI: 10.1016/j.tjog.2023.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2023] [Indexed: 05/29/2024] Open
Abstract
OBJECTIVE To explore a precise association between tumor location and lymph node (LN) biopsy algorithm in uterine confined endometrial cancer (EC). MATERIALS AND METHODS Patients with EC treated in the Department of Obstetrics and Gynecology, South Branch of Fujian Provincial Hospital were included in this observational retrospective study. Based on the procedure of treatment, patients were separated to stage I (2015.07-2019.09) and stage II (2019.09-2021.9). In each stage, patients were separated to high and low-risk group by the predicted results. Patients in the high-risk group received systematic lymphadenectomy in stage I and sentinel lymph node (SLN) dissection in stage II. The efficiency of lymph node metastasis (LNM) detection rates was compared between stage I and stage II cases. Precise lymph node biopsy algorithm was also constructed based on the outcomes of stage II. RESULTS Overall, 43 patients, 28 in stage I and 15 in stage II, were included in the study. No recurrence or death cases had been found within follow-up terms. Based on the difference in the detection efficiency of LNM (p > 0.05), there was no difference between two stages. Thus, systematic lymphadenectomy and SLN biopsy provided similar success rates. The location of tumor site was also important for deciding whether pelvic or para-aortic SLN should be sampled for LNM. CONCLUSIONS Precise SLN biopsy for EC confined to the uterus showed comparable LNM detection rate as systematic lymphadenectomy. EC location may be used to determine whether pelvic or para-aortic SLN sampling should be conducted for treatment.
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Affiliation(s)
- Xiao-Long Shi
- Provincial Clinical Medical College of Fujian Medical University, Fuzhou, Fujian Province, 350001, PR China; Department of Obstetrics and Gynecology, Fujian Provincial Hospital, Fuzhou, Fujian Province, 350001, PR China.
| | - Shuo Chen
- Provincial Clinical Medical College of Fujian Medical University, Fuzhou, Fujian Province, 350001, PR China; Department of Obstetrics and Gynecology, Fujian Provincial Hospital, Fuzhou, Fujian Province, 350001, PR China
| | - Guo-Dong Guo
- Provincial Clinical Medical College of Fujian Medical University, Fuzhou, Fujian Province, 350001, PR China; Department of Obstetrics and Gynecology, Fujian Provincial Hospital, Fuzhou, Fujian Province, 350001, PR China
| | - Yun-Ling Yang
- Provincial Clinical Medical College of Fujian Medical University, Fuzhou, Fujian Province, 350001, PR China; Department of Obstetrics and Gynecology, Fujian Provincial Hospital, Fuzhou, Fujian Province, 350001, PR China
| | - Kang-Mei Tong
- Provincial Clinical Medical College of Fujian Medical University, Fuzhou, Fujian Province, 350001, PR China; Department of Obstetrics and Gynecology, Fujian Provincial Hospital, Fuzhou, Fujian Province, 350001, PR China
| | - Wen Cao
- Provincial Clinical Medical College of Fujian Medical University, Fuzhou, Fujian Province, 350001, PR China; Department of Obstetrics and Gynecology, Fujian Provincial Hospital, Fuzhou, Fujian Province, 350001, PR China
| | - Lin-Lin Huang
- Provincial Clinical Medical College of Fujian Medical University, Fuzhou, Fujian Province, 350001, PR China; Department of Obstetrics and Gynecology, Fujian Provincial Hospital, Fuzhou, Fujian Province, 350001, PR China
| | - Yan-Ru Zhang
- Provincial Clinical Medical College of Fujian Medical University, Fuzhou, Fujian Province, 350001, PR China; Department of Obstetrics and Gynecology, Fujian Provincial Hospital, Fuzhou, Fujian Province, 350001, PR China
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Holtzman S, Stoffels G, Flint M, Carr C, Prasad-Hayes M, Zeligs K, Blank SV. Outcomes for patients with high-risk endometrial cancer undergoing sentinel lymph node assessment versus full lymphadenectomy. Gynecol Oncol 2023; 174:273-277. [PMID: 37270906 DOI: 10.1016/j.ygyno.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 04/25/2023] [Accepted: 05/01/2023] [Indexed: 06/06/2023]
Abstract
OBJECTIVE The objective of this study was to determine the progression free survival (PFS) and overall survival (OS) among patients with high-risk endometrial cancer (EC) who underwent sentinel lymph node (SLN) mapping and dissection compared to patients who underwent pelvic +/- para-aortic lymphadenectomy (LND). METHODS Patients with newly diagnosed high-risk EC were identified. Inclusion criteria included patients who underwent primary surgical management from January 1, 2014 to September 1, 2020 at our institution. Patients were categorized into either the SLN or LND group based on their method of planned lymph node assessment. Patients in the SLN group had dye injected followed by successful bilateral lymph node mapping, retrieval, and processing per our institutional protocol. Clinicopathological and follow-up data were extracted from patient's medical records. The t-test or Mann-Whitney test was used to compare continuous variables and Chi-squared or Fisher's exact test were used for categorical variables. Progression-free survival (PFS) was calculated from the date of initial surgery to the date of progression, death, or last follow-up. Overall survival (OS) was calculated from the date of surgical staging to the date of death or last follow-up. Three-year PFS and OS were calculated using the Kaplan-Meier method, and the log-rank test was used to compare cohorts. Multivariable Cox regression models were used to assess the relationship between nodal assessment cohort and OS/PFS while adjusting for age, adjuvant therapy, and surgical approach. A result was considered statistically significant at the p < 0.05 level of significance and all statistical analysis was done using SAS version 9.4 (SAS Institute, Cary, NC). RESULTS Out of 674 patients diagnosed with EC during the study period, 189 were diagnosed with high-risk EC based on our criteria. Forty-six (23.7%) patients underwent SLN assessment and 143 (73.7%) underwent LND. No difference was observed between the two groups in regards to age, histology, stage, body mass index, tumors myometrial invasion, lymphovascular space invasion, or peritoneal washing positivity. Patients in the SLN group underwent robotic-assisted procedures more frequently than those in the LND group (p < 0.0001). The three-year PFS rate was 71.1% (95% CI 51.3-84.0%) in the SLN group and 71.3% (95% CI 62.0-78.6%) in the LND group (p = 0.91). The unadjusted hazard ratio (HR) for recurrence in the SLN versus LND group was 1.11 (95% CI 0.56-2.18; p = 0.77), and after adjusting for age, adjuvant therapy, and surgical approach, the HR for recurrence was 1.04 (95% CI 0.47-2.30, p = 0.91). The three-year OS rate was 81.1% (95% CI 51.1-93.7%) in the SLN group and 95.1% (95% CI 89.4-97.8%) in the LND group (p = 0.009). Although the unadjusted HR for death was 3.74 in the SLN vs LND group (95% CI 1.39-10.09; p = 0.009), when adjusted for age, adjuvant therapy, and surgical approach, it was no longer significant with a HR of 2.90 (95% CI 0.94-8.95, p = 0.06). CONCLUSIONS There was no difference in three-year PFS in patients diagnosed with high-risk EC who underwent SLN evaluation compared to those who underwent full LND in our cohort. The SLN group did experience shorter unadjusted OS; however, when adjusting for age, adjuvant therapy and surgical approach, there was no difference OS in patients who underwent SLN compared to LND.
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Affiliation(s)
- Sharonne Holtzman
- Icahn School of Medicine at Mount Sinai, Department of Obstetrics, Gynecology and Reproductive Sciences, United States of America.
| | - Guillaume Stoffels
- Icahn School of Medicine at Mount Sinai, Department of Obstetrics, Gynecology and Reproductive Sciences, United States of America
| | - Matt Flint
- Icahn School of Medicine at Mount Sinai, Department of Obstetrics, Gynecology and Reproductive Sciences, United States of America
| | - Caitlin Carr
- Icahn School of Medicine at Mount Sinai, Department of Obstetrics, Gynecology and Reproductive Sciences, United States of America
| | - Monica Prasad-Hayes
- Icahn School of Medicine at Mount Sinai, Department of Obstetrics, Gynecology and Reproductive Sciences, United States of America
| | - Kristen Zeligs
- Icahn School of Medicine at Mount Sinai, Department of Obstetrics, Gynecology and Reproductive Sciences, United States of America
| | - Stephanie V Blank
- Icahn School of Medicine at Mount Sinai, Department of Obstetrics, Gynecology and Reproductive Sciences, United States of America
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Capozzi VA, Rosati A, Maglietta G, Vargiu V, Scarpelli E, Cosentino F, Sozzi G, Chiantera V, Ghi T, Scambia G, Berretta R, Fanfani F. Long-term survival outcomes in high-risk endometrial cancer patients undergoing sentinel lymph node biopsy alone versus lymphadenectomy. Int J Gynecol Cancer 2023:ijgc-2023-004314. [PMID: 37068852 DOI: 10.1136/ijgc-2023-004314] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2023] Open
Abstract
OBJECTIVE Endometrial cancer is the most common gynecologic neoplasm. To date, international guidelines recommend sentinel lymph node biopsy for low-risk neoplasms, while systematic lymphadenectomy is still considered for high-risk cases. This study aimed to compare the long-term survival of high-risk patients who were submitted to sentinel lymph node biopsy alone versus systematic pelvic lymphadenectomy. METHODS Patients with high-risk endometrial cancer according to the 2021 European Society of Gynaecological Oncology/European Society for Radiotherapy and Oncology/European Society of Pathology risk classification were retrospectively analyzed. The primary aim of the study was to compare the long-term overall survival and disease-free survival of high-risk endometrial cancer patients undergoing sentinel lymph node biopsy versus systematic lymphadenectomy. A supplementary post-hoc survival analysis of cases with nodal metastasis was performed to compare sentinel lymph node and lymphadenectomy survival outcomes in this subset of patients. RESULTS The study enrolled 237 patients with histologically proven high-risk endometrial cancer. Patients were followed up for a median of 31 months (IQR 18-40). During the follow-up, 38 (16.0%) patients had a recurrence, and 19 (8.0%) patients died. Disease-free survival (85.2% vs 82.8%; p=0.74) and overall survival (91.3% vs 92.6%; p=0.62) were not different between the sentinel lymph node alone and lymphadenectomy groups. Furthermore, neither overall survival (96.1% vs 91.4%; p=0.43) nor disease-free survival (83.7% vs 76.4%; p=0.46) were different among sentinel lymph node alone and lymphadenectomy groups in patients with nodal metastasis. CONCLUSIONS Sentinel lymph node mapping alone in high-risk endometrial cancer appears to be an oncologically safe technique over a long observational time. Systematic lymphadenectomy in this population does not offer a survival advantage.
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Affiliation(s)
- Vito Andrea Capozzi
- Department of medicine and surgery, University Hospital of Parma, Parma, Italy
| | - Andrea Rosati
- UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Giuseppe Maglietta
- Clinical and Epidemiological Research Unit, University of Parma, Parma, Italy
| | - Virginia Vargiu
- Department of Women's and Children's Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Elisa Scarpelli
- Department of medicine and surgery, University Hospital of Parma, Parma, Italy
| | - Francesco Cosentino
- Department of Medicine and Health Sciences, University of Molise Studies, Campobasso, Italy
- Department of Oncology, Gemelli Molise Spa, Campobasso, Italy
| | - Giulio Sozzi
- Department of Gynecologic Oncology, University of Palermo, Palermo, Italy
| | - Vito Chiantera
- Department of Gynecologic Oncology, University of Palermo, Palermo, Italy
| | - Tullio Ghi
- Department of medicine and surgery, University Hospital of Parma, Parma, Italy
| | - Giovanni Scambia
- Dipartimento Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Roberto Berretta
- Department of medicine and surgery, University Hospital of Parma, Parma, Italy
| | - Francesco Fanfani
- Division of Gynecologic Oncology, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
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Yao H, Luo R, Tong R, Wei Y, Zheng K, Hu X. Impact of sentinel lymph node assessment on the outcomes of patients with advanced endometrial cancer: A meta-analysis. Medicine (Baltimore) 2023; 102:e33465. [PMID: 37058063 PMCID: PMC10101267 DOI: 10.1097/md.0000000000033465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 03/16/2023] [Indexed: 04/15/2023] Open
Abstract
BACKGROUND Sentinel lymph node (SLN) assessment is used to treat early endometrial cancer; however, its application in advanced endometrial cancer remains controversial. Therefore, we assessed the effects of SLN assessment and lymphadenectomy (LND) on the prognosis (survival rate and primary outcome) of patients with advanced endometrial cancer. METHODS Pertinent studies were selected from PubMed, Embase, Web of Science, and the Cochrane Library until March 19, 2022. Relevant studies were strictly screened according to the inclusion and exclusion criteria. Data from the included studies were extracted and their quality was evaluated. Then RevMan5.4 software was used for the meta-analysis. RESULTS Four retrospective studies were included, which enrolled 7181 patients; 492 were treated with SLN and 6689 with LND. In terms of overall survival, there was no significant difference between the 2 groups (odds ratio = 1.14, 95% confidence interval: 0.92-1.41, I2 = 0%, P = .39). CONCLUSIONS SLN assessment is an alternative to LND as a treatment modality for advanced endometrial cancer.
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Affiliation(s)
- Huiyi Yao
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Ruiwen Luo
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Ruoyi Tong
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Yanwen Wei
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Kaiteng Zheng
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Xiangdan Hu
- Department of Gynecology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
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Yang XL, Zhang YE, Kou LN, Yang FL, Wu DJ. A population-based risk scoring system to individualize adjuvant treatment for stage IIIC endometrial cancer patients after surgery. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:475-480. [PMID: 36114049 DOI: 10.1016/j.ejso.2022.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 08/31/2022] [Accepted: 09/05/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND To develop a risk scoring system to tailor the adjuvant treatment for stage IIIC EC patients after surgery. METHODS Data source was from the Surveillance, Epidemiology, and End Results (SEER) registry, where 3251 post-operative stage IIIC EC patients with different adjuvant treatment were included. Cox regression analysis was used to identify risk factors. The exp (β) of each independent risk factors generating from the cox analysis was used to construct the risk scoring system, which was further utilized to divide the patients into different risk subgroups and the efficacy of different adjuvant modalities in each risk subgroups would be compared accordingly. RESULTS Six independent risk factors were identified to develop the scoring system, which further divided the patients into three risk subgroups based on the total risk score (Low-risk≤8.46, 8.47 ≤ Middle-risk≤9.94, High-risk≥9.95). This study revealed that CRT was not superior to RT alone (HR:1.208, 95%CI: 0.852-1.741; P = 0.289) or CT alone (HR:1.260, 95%CI: 0.750-2.116; P = 0.382) in Low-risk subgroup. We also observed that CRT had a survival advantage over other treatment modalities in the Middle-risk subgroup (All P < 0.001), but CRT and CT alone to be superimposable in the High-risk subgroup (HR: 1.395, 95%CI: 0.878-2.216; P = 0.159). CONCLUSION A risk scoring system has been developed to tailor the adjuvant treatment for stage IIIC EC patients after surgery, where RT or CT alone could be a substitute for CRT in Low-risk patients and CT alone was a potential alternative for High-risk patients while CRT remained to be the optimal choice for the Middle-risk patients.
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Affiliation(s)
- Xi-Lin Yang
- Department of Radiation Oncology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, China
| | - Yue-Er Zhang
- Department of Pain, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Ling-Na Kou
- Department of Medical Oncology, Sichuan Cancer Hospital&Institute, Chengdu, 610042, China
| | - Feng-Leng Yang
- Department of Radiology, Chengdu Women's and Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, China.
| | - Da-Jun Wu
- Department of Radiation Oncology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, China.
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Sentinel Lymph Node Mapping in High-Grade Endometrial Cancer. Curr Oncol 2022; 29:1123-1135. [PMID: 35200595 PMCID: PMC8870608 DOI: 10.3390/curroncol29020096] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/08/2022] [Accepted: 02/09/2022] [Indexed: 01/11/2023] Open
Abstract
Sentinel lymph node (SLN) mapping is becoming an acceptable alternative to full lymphadenectomy for evaluating lymphatic spread in clinical stage I endometrial cancer (EC). While the assessment of pelvic and para-aortic lymph nodes is part of the surgical staging of EC, there is a long-standing debate over the therapeutic value of full lymphadenectomy in this setting. Although lymphadenectomy offers critical information on lymphatic spread and prognosis, most patients will not derive oncologic benefit from this procedure as the majority of patients do not have lymph node involvement. SLN mapping offers prognostic information while simultaneously avoiding the morbidity associated with an extensive and often unnecessary lymphadenectomy. A key factor in the decision making when planning for EC surgery is the histologic subtype. Since the risk of lymphatic spread is less than 5% in low-grade EC, these patients might not benefit from lymph node assessment. Nonetheless, in high-grade EC, the risk for lymph node metastases is much higher (20–30%); therefore, it is crucial to determine the spread of disease both for determining prognosis and for tailoring the appropriate adjuvant treatment. Studies on the accuracy of SLN mapping in high-grade EC have shown a detection rate of over 90%. The available evidence supports adopting the SLN approach as an accurate method for surgical staging. However, there is a paucity of prospective data on the long-term oncologic outcome for patients undergoing SLN mapping in high-grade EC, and more trials are warranted to answer this question.
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Yang XL, Yang FL, Kou LN, Wu DJ, Xie C. Prognostic model for the exemption of adjuvant chemotherapy in stage IIIC endometrial cancer patients. Front Endocrinol (Lausanne) 2022; 13:989063. [PMID: 36387854 PMCID: PMC9643711 DOI: 10.3389/fendo.2022.989063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 10/05/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND This study aimed to develop a nomogram to predict the survival for stage IIIC endometrial cancer (EC) patients with adjuvant radiotherapy (ART) alone and personalize recommendations for the following adjuvant chemotherapy (ACT). METHODS In total, 746 stage IIIC EC patients with ART alone were selected from the Surveillance, Epidemiology, and End Results (SEER) registry. Cox regression analysis was performed to identify independent risk factors. A nomogram was developed accordingly, and the area under the receiver operating characteristic curve (AUC) and C-index were implemented to assess the predictive power. The patients were divided into different risk strata based on the total points derived from the nomogram, and survival probability was compared between each risk stratus and another SEER-based cohort of stage IIIC EC patients receiving ART+ACT (cohort ART+ACT). RESULTS Five independent predictors were included in the model, which had favorable discriminative power both in the training (C-index: 0.732; 95% CI: 0.704-0.760) and validation cohorts (C-index: 0.731; 95% CI: 0.709-0.753). The patients were divided into three risk strata (low risk <135, 135 ≤ middle risk ≤205, and high risk >205), where low-risk patients had survival advantages over patients from cohort ART+ACT (HR: 0.45, 95% CI: 0.33-0.61, P < 0.001). However, the middle- and high-risk patients were inferior to patients from cohort ART+ACT in survival (P < 0.001). CONCLUSION A nomogram was developed to exclusively predict the survival for stage IIIC EC patients with ART alone, based on which the low-risk patients might be perfect candidates to omit the following ACT. However, the middle- and high-risk patients would benefit from the following ACT.
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Affiliation(s)
- Xi-Lin Yang
- Department of Radiation Oncology, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Feng-Leng Yang
- Department of Radiology, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Ling-Na Kou
- Department of Medical Oncology, Sichuan Cancer Hospital and Institute, Chengdu, China
| | - Da-Jun Wu
- Department of Radiation Oncology, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- *Correspondence: Cong Xie, ; Da-Jun Wu,
| | - Cong Xie
- Department of Gynecology, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- *Correspondence: Cong Xie, ; Da-Jun Wu,
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Garzon S, Mariani A, Day CN, Habermann EB, Langstraat C, Glaser G, Kumar A, Casarin J, Uccella S, Ghezzi F, Larish A. Overall survival after surgical staging by lymph node dissection versus sentinel lymph node biopsy in endometrial cancer: a national cancer database study. Int J Gynecol Cancer 2021; 32:28-40. [PMID: 34750199 DOI: 10.1136/ijgc-2021-002927] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 10/18/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Substituting lymphadenectomy with sentinel lymph node biopsy for staging purposes in endometrial cancer has raised concerns about incomplete nodal resection and detrimental oncological outcomes. Therefore, this study aimed to investigate the association between the type of lymph node assessment and overall survival in endometrial cancer accounting for node status and histology. METHODS Women with stage I-III endometrial cancer who underwent hysterectomy and lymph node assessment from January 2012 to December 2015 were identified in the National Cancer Database. Patients who underwent neoadjuvant therapy, had previous cancer, and whose follow-up was less than 90 days were excluded. Multivariable Cox proportional hazards regression analyses were performed to assess factors associated with overall survival. RESULTS Of 68 614 patients, 64 796 (94.4%) underwent lymphadenectomy, 1777 (2.6%) underwent sentinel node biopsy only, and 2041 (3.0%) underwent both procedures. On multivariable analysis, neither sentinel lymph node biopsy alone nor sentinel node biopsy followed by lymphadenectomy was associated with significantly different overall survival compared with lymphadenectomy alone (HR 0.92, 95% CI 0.73 to 1.17, and HR 0.91, 95% CI 0.77 to 1.08, respectively). When stratified by lymph node status, sentinel node biopsy alone or followed by lymphadenectomy was not associated with different overall survival, both in patients with negative (HR 0.95, 95% CI 0.73 to 1.24, and HR 1.04, 95% CI 0.85 to 1.27, respectively) or positive (HR 0.91, 95% CI 0.54 to 1.52, and HR 0.77, 95% CI 0.57 to 1.04, respectively) lymph nodes. These findings held true when sentinel node biopsy alone and sentinel node biopsy plus lymphadenectomy groups were merged, and on stratification by histotype (type one vs type 2) or inclusion of only complete lymphadenectomy (at least 10 pelvic nodes and at least one para-aortic node removed). In all analyses, age, Charlson-Deyo score, black race, AJCC pathological T stage, grade, lymphovascular invasion, brachytherapy, and adjuvant chemotherapy were independently associated with overall survival. DISCUSSION No difference in overall survival was found in patients with endometrial cancer who underwent sentinel node biopsy alone, sentinel node biopsy followed by lymphadenectomy, or lymphadenectomy alone. This observation remained regardless of node status, histotype, and lymphadenectomy extent.
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Affiliation(s)
- Simone Garzon
- Department of Obstetrics and Gynecology, 'Filippo Del Ponte' Hospital, University of Insubria, Varese, Italy.,Department Obstetrics and Gynecology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Andrea Mariani
- Department Obstetrics and Gynecology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Courtney N Day
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Elizabeth B Habermann
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Carrie Langstraat
- Department Obstetrics and Gynecology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Gretchen Glaser
- Department Obstetrics and Gynecology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Amanika Kumar
- Department Obstetrics and Gynecology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Jvan Casarin
- Department Obstetrics and Gynecology, Mayo Clinic Rochester, Rochester, Minnesota, USA.,Department of Obstetrics and Gynecology, University of Insubria Faculty of Medicine and Surgery, Varese, Italy
| | - Stefano Uccella
- Department of Obstetrics and Gynecology, University of Verona, Verona, Italy
| | - Fabio Ghezzi
- Department of Obstetrics and Gynecology, 'Filippo Del Ponte' Hospital, University of Insubria, Varese, Italy
| | - Alyssa Larish
- Department Obstetrics and Gynecology, Mayo Clinic Rochester, Rochester, Minnesota, USA
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