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EPV119/#397 Volume of nodal disease and oncologic outcomes in endometrial cancer patients with positive sentinel lymph nodes: 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, Milan, Italy
  3. 3Università Cattolica del Sacro Cuore, Department of Woman and Child Health and Public Health, Woman Health Area, Fondazione Policlinico Universitario A. Gemelli Irccs, Roma, Italy
  4. 4’F. Miulli’ General Regional Hospital, Gynecologic Oncology Unit, Acquaviva Delle Fonti, Italy
  5. 5Fondazione IRCCS Policlinico San Matteo and University of Pavia, Department of Obstetrics and Gynecology, Pavia, Italy
  6. 6Endoscopica Malzoni, Center for Advanced Endoscopic Gynecological Surgery, Gynecological Surgery, Avellino, Italy
  7. 7University of Bologna, Gynecologic Oncology, Bologna, Italy
  8. 8University of Insubria, Gynecologic Oncology, Varese, Italy
  9. 9Azienda Ospedaliero Universitaria Pisana, Uo Ginecologia 2, Pisa, Italy
  10. 10A. O. Ordine Mauriziano Umberto I, Ginecologia E Ostetricia, Torino, Italy
  11. 11Cannizzaro Hospital of Catania, Unit of Obstetrics and Gynaecology, Catania, Italy
  12. 12Institute for Maternal and Child Health ‘IRCCS Burlo Garofolo’, Clinica Ostetrica E Ginecologica, Trieste, Italy


Objectives To asses predictive factors for sentinel-lymph-nodes (SLNs) involvement and recurrence-free-survival (RFS) in patients with endometrial cancer

Methods 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

Results 142 patients were identified among 12 participating centers. In 64.8% of cases a low-volume disease (≤2 mm) was found in SLNs: 33 (23.2%) ITCs and 59 (41.6%) micrometastases. Predictors of macrometastatic SLNs were: high grade [p:0.002], LVSI [p:0.007] and MI >50% [p:0.008]. 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.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].The only factors affecting RFS were deep MI [p:0.03] and cervical stromal invasion [p:0.046].

Conclusions 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.

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