Article Text

Download PDFPDF

252 Type of sentinel lymph nodes metastases and oncologic outcomes in endometrial cancer patients: an italian multi-institutional study
  1. F Martinelli1,
  2. A Buda2,
  3. F Fanfani3,
  4. F Legge4,
  5. M Roccio5,
  6. F Falcone6,
  7. AM Perrone7,
  8. J Casarin8,
  9. A Perutelli9,
  10. N Biglia10,
  11. P Scollo11,
  12. F Romano12,
  13. A Ditto1,
  14. D Ferrari2,
  15. G Monterossi3,
  16. F Murgia4,
  17. C Paniga2,
  18. G Scambia3 and
  19. F Raspagliesi1
  1. 1Fondazione IRCCS Istituto Nazionale Tumori of Milan, Gynecologic Oncology, Milan, Italy
  2. 2University of Milan Bicocca, UOC of Gynecology A.O. San Gerardo , Clinic of Obstetrics and Gynecology
  3. 3Fondazione Policlinico Universitario A. Gemelli Università Cattolica del Sacro Cuore
  4. 4Ospedale Generale Regionale ‘ F.Miulli’
  5. 5Fondazione IRCCS Policlinico San Matteo , U.O. di Ostetricia e Ginecologia
  6. 6Endoscopica Malzoni, Center for Advanced Endoscopic Gynecological Surgery
  7. 7IRCCS Azienda Ospedaliero-Universitaria di Bologna, Division of Oncologic Gynecology
  8. 8University of Insubria, Obstetrics and Gynecology Department Del Ponte Women’s and Children Hospital
  9. 9UO ginecologia 2 di Pisa
  10. 10Università di Torino SCDU Ginecologia e Ostetricia A. O. Ordine Mauriziano Umberto I
  11. 11Ospedale Cannizzaro, AO per l’Emergenza
  12. 12Institute for Maternal and Child Health ‘IRCCS Burlo Garofolo’, Trieste


Introduction/Background*The role of volume of sentinel lymph nodes (SLNs) disease (macro-micrometastases and ITCs) in endometrial cancer is not clearly defined. We aimed to asses predictive factors for SLNs involvement and recurrence free survival (RFS) in patients with endometrial cancer.

Methodology A multicenter retrospective evaluation of endometrial cancer patients with positive (macro-micro metastases or ITCs) SLNs, treated between 2003 and 2020, was performed. Predictive factors for nodal involvement (endometrioid vs non-endometrioid histology, grading, lymphovascular-space invasion (LVSI), myometrial invasion (MI), cervical stromal invasion, ESGO/ESTRO/ESP risk group), adjuvant therapy and oncological outcomes were evaluated.

Result(s)*142 patients were identified among 12 participating centers performing SLN mapping. In 64.8% of cases a low-volume disease (≤2 mm) was found in SLNs: 33 (23.2%) ITCs and 59 (41.6%) micrometastases. Factors influencing volume of nodal metastases were: grading [p:0.002] (G1 associated with low-volume disease), LVSI [p:0.007] and MI >50% [p:0.008] (both associated with macrometastases). There were: 20 (14.1%) low-risk, 14 (9.8%) intermediate, 88 (62%) high-intermediate and 20 (14.1%) high-risk according to 2020-ESGO/ESTRO/ESP risk group (on uterus). 17 (18.5%) patients with low-volume disease (8 micrometastases and 9 ITCs) did not receive any adjuvant therapy. At a mean follow-up of 34.6 months (range 1 –215) months, 21 (14.8%) relapses were recorded, only one among patients not receiving any adjuvant, none in the ESGO/ESTRO/ESP low risk group. The RFS at 2-years for the micrometastatic patients was 91%, similar to ITCs patients (79.1%), regardless of adjuvant treatment, but statistically better than patients with macrometastases (72.3%) [p: 0.026]. There was a trend to distinct RFS according to ESGO/ESTRO/ESP risk group, but none of the comparisons reached significance. The only factors affecting RFS were deep MI [p:0.03] and cervical stromal invasion [p:0.046].

Conclusion*More than half of patients with positive SLNs had low-volume disease. Grading, MI and LVSI predicted volume of nodal metastases. MI and cervical invasion affected RFS; while adjuvant treatment did not seem significantly associated with RFS in patients with low-volume disease. Longer follow-up time and a larger sample size are needed to understand the role of adjuvant therapy in low-volume metastatic SLNs.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.