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Buda A, Paniga C, Taskin S, Mueller M, Zapardiel I, Fanfani F, Puppo A, Casarin J, Papadia A, De Ponti E, Grassi T, Mauro J, Turan H, Vatansever D, Gungor M, Ortag F, Imboden S, Garcia-Pineda V, Mohr S, Siegenthaler F, Perotto S, Landoni F, Ghezzi F, Scambia G, Taskiran C, Fruscio R. The Risk of Recurrence in Endometrial Cancer Patients with Low-Volume Metastasis in the Sentinel Lymph Nodes: A Retrospective Multi-Institutional Study. Cancers (Basel) 2023; 15:cancers15072052. [PMID: 37046712 PMCID: PMC10093146 DOI: 10.3390/cancers15072052] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 03/24/2023] [Accepted: 03/27/2023] [Indexed: 04/14/2023] Open
Abstract
The aim of this study was to assess the impact of low-volume metastasis (LVM) on disease-free survival (DFS) in women with apparent early-stage endometrial cancer (EC) who underwent sentinel lymph node (SLN) mapping. Patients with pre-operative early-stage EC were retrospectively collected from an international collaboration including 13 referring institutions. A total of 1428 patients were included in this analysis. One hundred and eighty-six patients (13%) had lymph node involvement. Fifty-nine percent of positive SLN exhibited micrometastases, 26.9% micrometastases, and 14% isolated tumor cells. Seventeen patients with positive lymph nodes did not receive any adjuvant therapy. At a median follow-up of 33.3 months, the disease had recurred in 114 women (8%). Patients with micrometastases in the lymph nodes had a worse prognosis of disease-free survival compared to patients with negative nodes or LVM. The rate of recurrence was significantly higher for women with micrometastases than those with low-volume metastases (HR = 2.61; p = 0.01). The administration of adjuvant treatment in patients with LVM, without uterine risk factors, remains a matter of debate and requires further evaluation.
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Affiliation(s)
- Alessandro Buda
- Department of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
- Clinic of Obstetrics and Gynecology, IRCCS San Gerardo, 20900 Monza, Italy
- Division of Gynecologic Oncology, Ospedale Michele e Pietro Ferrero, 12060 Verduno, Italy
| | - Cristiana Paniga
- Department of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
- Clinic of Obstetrics and Gynecology, IRCCS San Gerardo, 20900 Monza, Italy
| | - Salih Taskin
- Department of Obstetrics and Gynecology, School of Medicine, Ankara University, 06620 Ankara, Turkey
| | - Michael Mueller
- Inselspital, University Hospital of Bern, University of Bern, 3010 Bern, Switzerland
| | - Ignacio Zapardiel
- Gynecologic Oncology Unit, La Paz University Hospital, 28046 Madrid, Spain
| | - Francesco Fanfani
- Department of Woman and Child Health and Public Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Department of Women and Child Health and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Andrea Puppo
- Department of Obstetrics and Gynecology, Ospedale Santa Croce e Carle, 12100 Cuneo, Italy
| | - Jvan Casarin
- Department of Obstetrics and Gynecology, 'Filippo Del Ponte' Hospital, University of Insubria, 21100 Varese, Italy
| | - Andrea Papadia
- Department of Gynecology and Obstetrics, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland
- Faculty of Biomedical Sciences, University of the Italian Switzerland, 6900 Lugano, Switzerland
| | - Elena De Ponti
- Medical Physics Department, Foundation IRCCS San Gerardo Hospital, 20900 Monza, Italy
| | - Tommaso Grassi
- Department of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
- Clinic of Obstetrics and Gynecology, IRCCS San Gerardo, 20900 Monza, Italy
| | - Jessica Mauro
- Division of Gynecologic Oncology, Ospedale Michele e Pietro Ferrero, 12060 Verduno, Italy
| | - Hasan Turan
- Department of Obstetrics and Gynecology, İstanbul Training and Research Hospital, University of Health Sciences, 34766 İstanbul, Turkey
| | - Dogan Vatansever
- Department of Obstetrics and Gynecology, School of Medicine, Koc University, 34450 İstanbul, Turkey
| | - Mete Gungor
- Department of Obstetrics and Gynecology, School of Medicine, Acibadem University, 34750 İstanbul, Turkey
| | - Firat Ortag
- Department of Obstetrics and Gynecology, School of Medicine, Ankara University, 06620 Ankara, Turkey
| | - Sara Imboden
- Inselspital, University Hospital of Bern, University of Bern, 3010 Bern, Switzerland
| | | | - Stefan Mohr
- Inselspital, University Hospital of Bern, University of Bern, 3010 Bern, Switzerland
| | | | - Stefania Perotto
- Division of Gynecologic Oncology, Ospedale Michele e Pietro Ferrero, 12060 Verduno, Italy
| | - Fabio Landoni
- Department of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
- Clinic of Obstetrics and Gynecology, IRCCS San Gerardo, 20900 Monza, Italy
| | - Fabio Ghezzi
- Department of Obstetrics and Gynecology, 'Filippo Del Ponte' Hospital, University of Insubria, 21100 Varese, Italy
| | - Giovanni Scambia
- Department of Woman and Child Health and Public Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Department of Women and Child Health and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Cagatay Taskiran
- Department of Obstetrics and Gynecology, School of Medicine, Koc University, 34450 İstanbul, Turkey
| | - Robert Fruscio
- Department of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
- Clinic of Obstetrics and Gynecology, IRCCS San Gerardo, 20900 Monza, Italy
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