Survival implication of lymphadenectomy in patients surgically treated for apparent early-stage uterine serous carcinoma

Jvan Casarin, Giorgio Bogani, Elisa Piovano, Francesca Falcone, Federico Ferrari, Franco Odicino, Andrea Puppo, Ferdinando Bonfiglio, Nicoletta Donadello, Ciro Pinelli, Antonio Simone Laganà, Antonino Ditto, Mario Malzoni, Stefano Greggi, Francesco Raspagliesi, Fabio Ghezzi

Research output: Contribution to journalArticle

Abstract

Objective: Uterine serous carcinoma (USC) is a rare highly aggressive disease. In the present study, we aimed to investigate the survival implication of the systematic lymphadenectomy in patients who underwent surgery for apparent early-stage USC. Methods: Consecutive patients with apparent early-stage USC surgically treated at six Italian referral cancer centers were analyzed. A comparison was made between patients who underwent retroperitoneal staging including at least pelvic lymphadenectomy “LND” vs. those who underwent hysterectomy alone “NO-LND”. Baseline, surgical and oncological outcomes were analyzed. Kaplan-Meier curves were calculated for disease-free survival (DFS) and disease-specific survival (DSS). Associations were evaluated with Cox proportional hazard regression and summarized using hazard ratio (HR). Results: One hundred forty patients were analyzed, 106 LND and 34 NO-LND. NO-LND group (compared to LND group) included older patients (median age, 73 vs.67 years) and with higher comorbidities (median Charlson Comorbidity Index, 6 vs. 5) (p<0.001). No differences in terms of recurrence rate (LND vs. NO-LND, 33.1% vs. 41.4%; p=0.240) were observed. At Cox regression analysis lymphadenectomy did not significantly influence DFS (HR=0.59; 95% confidence interval [CI]=0.32–1.08; p=0.09), and DSS (HR=0.14; 95% CI=0.02–1.21; multivariable analysis p=0.07). Positive node was independently associated with worse DFS (HR=6.22; 95% CI=3.08–12.60; p<0.001) and DSS (HR=5.51; 95% CI=2.31– 13.10; p<0.001), while adjuvant chemotherapy was associated with improved DFS (HR=0.38; 95% CI=0.17–0.86; p=0.02) and age was independently associated with worse DSS (HR=1.07; 95% CI=1.02–1.13; p<0.001). Conclusions: Although lymphadenectomy did not show survival benefits in patients who underwent surgery for apparent early-stage USC, the presence of lymph node metastasis was the main adverse prognostic factors, supporting the prognostic role of the retroperitoneal staging also in this histological subtype.

Original languageEnglish
Article numbere64
Pages (from-to)1-11
Number of pages11
JournalJournal of Gynecologic Oncology
Volume31
Issue number5
DOIs
Publication statusPublished - Sep 2020

Keywords

  • Endometrial Neoplasms
  • Gynecology
  • Lymphadenectomy
  • Survival
  • Therapeutics

ASJC Scopus subject areas

  • Oncology
  • Obstetrics and Gynaecology

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    Casarin, J., Bogani, G., Piovano, E., Falcone, F., Ferrari, F., Odicino, F., Puppo, A., Bonfiglio, F., Donadello, N., Pinelli, C., Laganà, A. S., Ditto, A., Malzoni, M., Greggi, S., Raspagliesi, F., & Ghezzi, F. (2020). Survival implication of lymphadenectomy in patients surgically treated for apparent early-stage uterine serous carcinoma. Journal of Gynecologic Oncology, 31(5), 1-11. [e64]. https://doi.org/10.3802/jgo.2020.31.e64