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11 Oncologic outcomes and role of adjuvant therapy in endometrial cancer patients with low volume metastasis in the sentinel lymph nodes: an international multi-institutional study
  1. K Ghoniem1,
  2. G Dinoi2,
  3. A Larish1,
  4. X Zhou3,
  5. M AlHilli4,
  6. S Wallace5,
  7. C Wohlmuth6,
  8. G Baiocchi7,
  9. N Tokgozoglu8,
  10. F Raspagliesi9,
  11. A Buda10,
  12. V Zanagnolo11,
  13. I Zapardiel12,
  14. N Jagasia13,
  15. R Giuntoli14,
  16. A Glickman15,
  17. M Peiretti16,
  18. M Lanner17,
  19. E Chacon18,
  20. J Di Guilmi19,
  21. A Pereira20,
  22. E Faron21,
  23. A Fishman22,
  24. C Nitschmann23,
  25. S Parker3,
  26. A Joehlin-Price4,
  27. B Lees5,
  28. A Covens6,
  29. L De Brot7,
  30. C Taskiran8,
  31. G Bogani9,
  32. C Paniga10,
  33. F Multinu11,
  34. A Hernandez-Gutierrez12,
  35. AL Weaver24,
  36. ME McGree24 and
  37. A Mariani1
  1. 1Department of Obstetrics and Gynecology, Mayo Clinic, USA
  2. 2Universita Cattolica del Sacro Cuore, Italy
  3. 3Hartford HealthCare, USA
  4. 4Cleveland Clinic, USA
  5. 5University of Wisconsin School of Medicine and Public Health, USA
  6. 6Sunnybrook Health Sciences, University of Toronto, Canada
  7. 7A.C. Camargo Cancer Center, Brazil
  8. 8Turkish Society of Gynecologic Oncology, Turkey
  9. 9Fondazione IRCCS Istituto Nazionale Tumori -Milan, Italy
  10. 10University of Milano-Bicocca, Italy
  11. 11IEO, European Institute of Oncology IRCCS, Italy
  12. 12La Paz University Hospital-IdiPAZ, Spain
  13. 13Mater Hospital Brisbane and Mater Research Institute, University of Queensland, Australia
  14. 14University of Pennsylvania Health System, USA
  15. 15Barcelona Clinic Hospital, Spain
  16. 16University of Cagliari, Italy
  17. 17Medical University of Graz, Austria
  18. 18Clínica Universidad de NavarraClínica Universidad de Navarra, Spain
  19. 19Hospital Britanico de Buenos Aires, Argentina
  20. 20Hospital Universitario Puerta de Hierro-Majadahonda, Spain
  21. 21Breast, gynecology and reconstructive Surgery Unit, Curie Institute, France
  22. 22Meir Medical Center, Faculty of Medicine – Tel-Aviv University, Israel
  23. 23Lahey Clinic, USA
  24. 24Department of Health Sciences Research, Mayo Clinic, USA


Objective To assess recurrence-free survival (RFS) and role of adjuvant therapy (ATx) in endometrial cancer with low volume metastasis (LVM) in sentinel lymph nodes (SLN).

Methods Patients with SLN LVM (≤2 mm) during 2010–2018 were retrospectively collected from 22 centers; stage IV, adnexal involvement, or unknown ATx were excluded. High-risk characteristics were grade (G) 3, non-endometrioid (NE) histology, lymphovascular invasion (LVSI), uterine serosal invasion (USI), or cervical stromal invasion.

Results 243 patients were included [131 isolated tumor cells (ITCs); 112 micro-metastasis (MM)]. The 186 patients who received ATx (external beam radiation therapy and/or chemotherapy) were more likely to be high-risk (75.3% vs. 38.6%) or have MM (55.9% vs. 14.0%) compared to patients without ATx. RFS was 78.1% (95% CI, 70.5–86.5%) at 4 years; median follow-up of patients without recurrence was 29.6 (IQR, 19.1–41.5) months.

The 4-yr RFS was 83.8% (95% CI 73.1–96.1%) among 57 patients without ATx; no significant risk factors identified. In particular, there were 18 G1 non-high-risk patients with ITC and no ATx, of which only 1 has recurred.

G3, NE, LVSI, and USI were associated with recurrence in patients receiving ATx (table 1). G3 or NE patients had poor outcome even with receiving ATx, the 4-yr RFS was 59.5% and 56.1%, respectively.

Abstract 11 Table 1

Results from univariate Cox proportional hazards models evaluating factors for an association with recurrence within the first 4 years following surgery among the 186 patients who received external beam radiation therapy and/or chemotherapy ± vaginal brachytherapy

Conclusion In patients with SLN LVM who received ATx, G3, NE, LVSI, and USI were strong prognostic factors. ITCs patients with G1 and non-high-risk characteristics have good prognosis even without ATx; further analysis is needed, when this cohort matures, to know if ATx can be confidently spared.

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