Introduction/Background Sentinel node mapping and pathological ultrastaging has increased the detection of low-volume disease (LVD). The prognostic value and appropriate adjuvant treatment of LVD is still controversial in endometrial cancer (EC).
Methodology 207 consecutive patients undergoing surgery for EC between June 2014 and December 2018 at the Donostia University Hospital in San Sebastian (Spain) were studied. All underwent sentinel lymph node biopsy after a double injection, both in the uterine fundus and cervix, of indocyanine green. Use of adjuvant treatment and overall and recurrence free survival were analyzed among those showing nodal disease.
Results Node metastasis was found in 38 patients (18.4%) of which 18 (47.4%) were macrometastasis and 20 (52.6%) were LVD; 8 (21.1%) micrometastasis and 12 (31.6%) isolated tumor cells. Fifteen (75%) of patients with LVD received adjuvant treatment, less than patients with macrometastasis (94.4%).
Overall survival was higher in LVD group compared to patients with macrometastasis (p 0.026). 94.1% and 72.2% of patients with macrometastasis were alive after one and two-year follow-up respectively, while no deaths were reported in patients with LVD in this period.
With a mean follow-up of 41.8 months, progression free survival was also higher (p 0.107) among patients with LVD (90%) compared to those with macrometastasis (66.7%). Both cases with recurrence in LVD group happened within the first year after surgery and showed high risk factors: grade 3 with myometrial invasion and type 2 tumor. Both of them received adjuvant therapy.
No cases of recurrence or death were found among patients with LVD that didn´t receive any adjuvant treatment.
Conclusion Optimal treatment and prognosis in patients with endometrial cancer showing low volume nodal disease are not well defined. Implementation of a method which would allow clustering these cases for a better study of them would be useful.
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