Multicenter study comparing oncologic outcomes after lymph node assessment via a sentinel lymph node algorithm versus comprehensive pelvic and paraaortic lymphadenectomy in patients with serous and clear cell endometrial carcinoma Journal Article


Authors: Schlappe, B. A.; Weaver, A. L.; McGree, M. E.; Ducie, J.; Eriksson, A. G. Z.; Dowdy, S. C.; Cliby, W. A.; Glaser, G. E.; Abu-Rustum, N. R.; Mariani, A.; Leitao, M. M. Jr
Article Title: Multicenter study comparing oncologic outcomes after lymph node assessment via a sentinel lymph node algorithm versus comprehensive pelvic and paraaortic lymphadenectomy in patients with serous and clear cell endometrial carcinoma
Abstract: Objectives: To compare survival after nodal assessment using a sentinel lymph node (SLN) algorithm versus comprehensive pelvic and paraaortic lymphadenectomy (LND) in serous or clear cell endometrial carcinoma, and to compare survival in node-negative cases. Methods: Three-year recurrence-free survival (RFS) and overall survival were compared between one institution that used comprehensive LND to the renal veins and a second institution that used an SLN algorithm with ultra-staging with inverse-probability of treatment weighting (IPTW) derived from propensity scores to adjust for covariate imbalance between cohorts. Results: 214 patients were identified (118 SLN cohort, 96 LND cohort). Adjuvant therapy differed between the cohorts; 84% and 40% in the SLN and LND cohorts, respectively, received chemotherapy ± radiation therapy. The IPTW-adjusted 3-year RFS rates were 69% and 80%, respectively. The IPTW-adjusted 3-year OS rates were 88% and 77%, respectively. The IPTW-adjusted hazard ratio (HR) for the association of surgical approach (SLN vs LND) with progression and death was 1.46 (95% CI: 0.70–3.04) and 0.44 (95% CI: 0.19–1.02), respectively. In the 168 node-negative cases, the IPTW-adjusted 3-year RFS rates were 73% and 91%, respectively. The IPTW-adjusted 3-year OS rates were 88% and 86%, respectively. In this subgroup, IPTW-adjusted HR for the association of surgical approach (SLN vs LND) with progression and death was 3.12 (95% CI: 1.02–9.57) and 0.69 (95% CI: 0.24–1.95), respectively. Conclusion: OS was not compromised with the SLN algorithm. SLN may be associated with a decreased RFS but similar OS in node-negative cases despite the majority receiving chemotherapy. This may be due to differences in surveillance. © 2019 Elsevier Inc.
Keywords: cancer survival; controlled study; human tissue; treatment outcome; aged; major clinical study; overall survival; cancer growth; cancer adjuvant therapy; cancer staging; endometrial cancer; antineoplastic agent; endometrium carcinoma; hysterectomy; lymph node dissection; paraaortic lymph node; pelvis lymph node; salpingooophorectomy; sentinel lymph node; lymphadenectomy; pelvis lymphadenectomy; cohort analysis; surgical approach; cancer mortality; algorithm; multicenter study; brachytherapy; external beam radiotherapy; dye; clear cell carcinoma; kidney vein; recurrence free survival; indocyanine green; adjuvant chemoradiotherapy; human; female; priority journal; article; clear cell endometrial carcinoma; serous endometrial carcinoma
Journal Title: Gynecologic Oncology
Volume: 156
Issue: 1
ISSN: 0090-8258
Publisher: Elsevier Inc.  
Date Published: 2020-01-01
Start Page: 62
End Page: 69
Language: English
DOI: 10.1016/j.ygyno.2019.11.002
PUBMED: 31776037
PROVIDER: scopus
PMCID: PMC6980738
DOI/URL:
Notes: Article -- Export Date: 3 February 2020 -- Source: Scopus
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MSK Authors
  1. Mario Leitao
    454 Leitao
  2. Jennifer A Ducie
    18 Ducie