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Lymphadenectomy in Early-Stage Intermediate-/High-Risk Endometrioid Endometrial Cancer: Clinical Characteristics and Outcomes in an Australian Cohort
  1. Rhonda Farrell, MS*,
  2. Suzanne C. Dixon, MEpi,,
  3. Jonathan Carter, MD§ and
  4. Penny M. Webb, PhD,
  1. * Royal Hospital for Women and Prince of Wales Private Hospital, Sydney, New South Wales;
  2. Gynaecological Cancers Group, QIMR Berghofer Medical Research Institute;
  3. School of Public Health, University of Queensland, Brisbane, Queensland;
  4. § Gynaecological Cancer Centre, Chris O’Brien Lifehouse, Sydney, New South Wales; and
  5. Gynaecological Cancers Group, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.
  1. Address correspondence and reprint requests to Rhonda Farrell, MS, Royal Hospital for Women and Prince of Wales Private Hospital, Suite 30, Level 7, Prince of Wales Private Hospital, Randwick, Sydney, New South Wales, Australia 2031. E-mail: rhondafarrell{at}mac.com.

Abstract

Objective The role of lymphadenectomy (LND) in early-stage endometrial cancer (EC) remains controversial. Previous studies have included low-risk patients and nonendometrioid histologies for which LND may not be beneficial, whereas long-term morbidity after LND is unclear. In a large Australian cohort of women with clinical early-stage intermediate-/high-risk endometrioid EC, we analyzed the association of LND with clinicopathological characteristics, adjuvant treatment, survival, patterns of disease recurrence, and morbidity.

Materials and Methods From a larger prospective study (Australian National Endometrial Cancer Study), we analyzed data from 328 women with stage IA grade 3 (n = 63), stage IB grade 1 to 3 (n = 160), stage II grade 1 to 3 (n = 71), and stage IIIC1/2 grade 1 to 3 (n = 31/3) endometrioid EC. Overall survival (OS) was estimated using Kaplan-Meier methods. The association of LND with OS was assessed using Cox regression analysis adjusted for age, stage, grade, and adjuvant treatment. The association with risk of recurrent disease was analyzed using logistic regression adjusted for age, stage, and grade. Morbidity data were analyzed using χ2 tests.

Results Median follow-up was 45.8 months. Overall survival at 3 years was 93%. Lymphadenectomy was performed in 217 women (66%), 16% of this group having positive nodes. Median node count was 12. There were no significant differences in OS between LND and no LND groups, or by number of nodes removed. After excluding stage IB grade 1/2 tumors, there was no association between LND and OS among a “high-risk” group of 190 women with a positive node rate of 24%. However, a similar cohort (n = 71) of serous EC in the Australian National Endometrial Cancer Study had improved survival after LND. Women who underwent LND had significantly higher rates of critical events (5% vs 0%, P = 0.02) and lymphoedema (23% vs 4%, P < 0.0001).

Conclusions In this cohort with early-stage intermediate-/high-risk endometrioid EC, LND did not improve survival but was associated with significantly increased morbidity.

  • Endometrial cancer
  • Endometrioid
  • Intermediate/high risk
  • Lymphadenectomy
  • Lymphoedema
  • Surgical morbidity

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Footnotes

  • The authors declare no conflicts of interest.