Sentinel node mapping vs. sentinel node mapping plus back-up lymphadenectomy in high-risk endometrial cancer patients: Results from a multi-institutional study

Giorgio Bogani, Andrea Papadia, Alessandro Buda, Jvan Casarin, Violante Di Donato, Maria Luisa Gasparri, Francesco Plotti, Ciro Pinelli, Maria Chiara Paderno, Salvatore Lopez, Anna Myriam Perrone, Fabio Barra, Rocco Guerrisi, Claudia Brusadelli, Antonella Cromi, Debora Ferrari, Valentina Chiapp, Mauro Signorelli, Umberto Leone Roberti Maggiore, Antonino DittoInnocenza Palaia, Simone Ferrero, Pierandrea De Iaco, Roberto Angioli, Pierluigi Benedetti Panici, Fabio Ghezzi, Fabio Landoni, Michael D. Mueller, Francesco Raspagliesi

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: Sentinel node mapping (SLN) has replaced lymphadenectomy for staging surgery in apparent early-stage low and intermediate risk endometrial cancer (EC). Only limited data about the adoption of SNM in high risk EC is still available. Here, we evaluate the outcomes of high-risk EC undergoing SNM (with or without back-up lymphadenectomy). Methods: This is a multi-institutional international retrospective study, evaluating data of high-risk (FIGO grade 3 endometrioid EC with myometrial invasion >50% and non-endometrioid histology) EC patients undergoing SNM followed by back-up lymphadenectomy and SNM alone. Results: Chart of consecutive 196 patients were evaluated. The study population included 83 and 113 patients with endometrioid and non-endometrioid EC, respectively. SNM alone and SNM followed by back-up lymphadenectomy were performed in 50 and 146 patients, respectively. Among patients having SNM alone, 14 (28%) were diagnosed with nodal disease. In the group of patients undergoing SNM plus back-up lymphadenectomy 34 (23.2%) were diagnosed with nodal disease via SNM. Back-up lymphadenectomy identified 2 (1%) additional patients with nodal disease (in the para-aortic area). Back-up lymphadenectomy allowed to remove adjunctive positive nodes in 16 (11%) patients. After the adoption of propensity-matched algorithm, we observed that patients undergoing SNM plus back-up lymphadenectomy experienced similar disease-free survival (p = 0.416, log-rank test) and overall survival (p = 0.940, log-rank test) than patients undergoing SLN alone. Conclusions: Although the small sample size, and the retrospective study design this study highlighted that type of nodal assessment did not impact survival outcomes in high-risk EC. Theoretically, back-up lymphadenectomy would be useful in improving the removal of positive nodes, but its therapeutic value remains controversial. Further prospective evidence is needed.

Original languageEnglish
JournalGynecologic Oncology
DOIs
Publication statusAccepted/In press - 2021

Keywords

  • Endometrial cancer
  • Lymphadenectomy
  • Sentinel node
  • Staging
  • Survival

ASJC Scopus subject areas

  • Oncology
  • Obstetrics and Gynaecology

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