Systematic lymphadenectomy in early stage endometrial cancer

• Published in: Archives of gynecology and obstetrics Vol. 302; no. 1; pp. 231 - 239
• Main Authors: Ignatov, Atanas, Ivros, Stylianos, Bozukova, Mihaela, Papathemelis, Thomas, Ortmann, Olaf, Eggemann, Holm
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-07-2020; Springer Nature B.V
• Subjects: Endocrinology; Endometrial cancer; Gynecologic Oncology; Gynecology; Human Genetics; Lymphatic system; Medicine; Medicine & Public Health; Obstetrics/Perinatology/Midwifery; Patients; Pelvis; Survival analysis; Lymphadenectomy; Endometrial cancer; Pelvic; Para-aortal
• ISSN: 0932-0067; 1432-0711
• DOI: 10.1007/s00404-020-05600-8

Background
The positive effect of systematic lymphadenectomy on survival of patients with endometrial cancer is a topic of ongoing debate.
Methods
We aimed to investigate whether systemic lymphadenectomy is beneficial for patients with early endometrial cancer. For this purpose, we analyzed a population-based registry with of 2392 women with endometrioid endometrial cancer, stage I and II at intermediate and high risk of recurrence. The primary outcome measure was overall survival.
Results
After exclusions, 868 women were eligible for analysis. Of those, 511 and 357 were categorized as intermediate (pT1A G3 and pT1B G1-2) and high risk (pT1B G3 and pT2 G1-3) early stage endometrial cancer, respectively. Lymphadenectomy was performed in 527 (60.7%) of the cases. Patients in the lymphadenectomy group were significantly younger, presented with more tumors of intermediate or undifferentiated grade and exhibited significantly lower co-morbidity rates and Eastern Cooperative of Oncology Group (ECOG) performance status. Median follow-up was 6.7 years. Recurrence-free survival was not improved by lymphadenectomy in the intermediate and high-risk group of patients. During the follow-up period, 111 (12.8%) women had disease recurrence and 302 (34.8%) died. Systematic lymphadenectomy was associated with significant improvement of overall survival in the pT1A G3 and pT1B G3 patient subgroups. Notably, adjustment for patient age and ECOG status abolished the improvement of overall survival by systematic lymphadenectomy in all groups. Thus, lymphadenectomy did not improve recurrence-free survival in the intermediate risk or the high-risk group of patients
Conclusions
Systematic pelvic and para-aortic lymphadenectomy did not improve the survival of patients with early stage I and II endometrioid endometrial cancer at intermediate and high risk of recurrence.