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Does lymphadenectomy improve survival in patients with intermediate risk endometrial cancer? A multicentric study from the FRANCOGYN Research Group
  1. Lilia Bougherara1,
  2. Henri Azaïs1,
  3. Hélène Béhal2,
  4. Geoffroy Canlorbe3,
  5. Marcos Ballester3,
  6. Sofiane Bendifallah3,
  7. Charles Coutant4,
  8. Vincent Lavoue5,
  9. Lobna Ouldamer6,
  10. Olivier Graesslin7,
  11. Cyril Touboul8,
  12. Juan Pablo Estevez1 and
  13. Pierre Collinet1
  1. 1 Department of Obstetrics and Gynaecology, Centre Hospitalier Régional Universitaire, Lille, France
  2. 2 Department of Biostatistics, Univ. Lille, CHU Lille, EA 2694 - Santé publique: épidémiologie et qualité des soins, Lille, France
  3. 3 Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre and Marie Curie, Institut Universitaire de Cancérologie (IUC), Paris, France
  4. 4 Centre de lutte contre le cancer Georges François Leclerc, Dijon, France
  5. 5 CRLCC Eugène-Marquis, Service de Gynécologie, CHU de Rennes, Université de Rennes 1, Rennes, France
  6. 6 Department of Obstetrics and Gynaecology, Centre hospitalier régional universitaire de Tours, hôpital Bretonneau, Tours, France
  7. 7 Department of Obstetrics and Gynaecology, Institute Alix de Champagne University Hospital, Reims, France
  8. 8 Department of Obstetrics and Gynaecology, Centre Hospitalier Intercommunal, Créteil, France
  1. Correspondence to Lilia Bougherara, Department of Obstetrics and Gynecology, Centre Hospitalier Régional Universitaire, Lille, France; liliabou{at}gmail.com

Abstract

Objective The role of lymphadenectomy in intermediate risk endometrial cancer remains uncertain. We evaluated the impact of lymphadenectomy on overall survival and relapse-free survival for patients with intermediate risk endometrial cancer.

Methods We retrospectively reviewed patients from the FRANCOGYN database with intermediate risk endometrial cancer, based on pre-operative and post-operative criteria (type 1, grade 1–2 tumors with deep (> 50%) myometrial invasion and no lymphovascular space invasion), who received primary surgical treatment between November 2002 and August 2013. We compared overall survival and relapse-free survival between staged and unstaged patients.

Results From 1235 screened patients, we selected 108 patients with intermediate risk endometrial cancer. Eighty-two (75.9%) patients underwent nodal staging (consisting of pelvic +/- para-aortic lymphadenectomy). Among them, 35 (32.4%) had lymph node disease. The median follow-up was 25 months (range 0.4 to 155.0). The overall survival rates were 82.5% for patients staged (CI 64.2 to 91.9) vs 77.9 % for unstaged patients (CI 35.4 to 94.2) (P = 0.73). The relapse-free survival rates were 68.9% for staged patients (CI 51.2 to 81.3) vs 68.8% for unstaged patients (CI 29.1 to 89.3) (P=0.67).

Conclusion Systematic nodal staging does not appear to improve overall survival and relapse-free survival for patients with IR EC but could provide information to tailor adjuvant therapy. Sentinel lymph node dissection may be an effective and less invasive alternative staging technique and should provide a future alternative for this population.

  • endometrial cancer
  • Intermediate risk
  • Endometrioid
  • recurrence risk
  • lymphadenectomy
  • sentinel lymph node procedure

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Footnotes

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval The research protocol was approved by the Institutional Review Board of the French College of Obstetrics and Gynecology (CEROG 2014-GYN-020).

  • Provenance and peer review Not commissioned; externally peer reviewed.

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