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EPV140/#62 Survival outcomes in endometrial cancer patients having lymphadenectomy, sentinel node mapping plus back-up lymphadenectomy and sentinel node mapping alone
  1. G Bogani1,
  2. F Ghezzi2,
  3. R Angioli3,
  4. A Papadia4,
  5. A Buda5,
  6. V Di Donato6,
  7. F Plotti3,
  8. P De Iaco7,
  9. AM Perrone7,
  10. S Ferrero8,
  11. U Leone Roberti Maggiore1,
  12. ML Gasparri4,
  13. J Casarin2,
  14. L Muzii6,
  15. M Mueller9,
  16. M Malzoni10,
  17. F Landoni5,
  18. P Benedetti Panici6 and
  19. F Raspagliesi1
  1. 1Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Gynecologic Oncology, Milano, Italy
  2. 2University of Insubria, Gynecologic Oncology, Varese, Italy
  3. 3Campus Biomedico, Gynecologic Oncology, Rome, Italy
  4. 4University of Lugano, Gynecologic Oncology, Lugano, Switzerland
  5. 5Bicocca University, Gynecologic Oncology, Milan, Italy
  6. 6Sapienza University, Gynecologic Oncology, Rome, Italy
  7. 7University of Bologna, Gynecologic Oncology, Bologna, Italy
  8. 8University of Genoa, Gynecologic Oncology, Genova, Italy
  9. 9University of Bern, Gynecologic Oncology, Bern, Switzerland
  10. 10Malzoni Medical Center, Gynecologic Oncology, Avellino, Italy


Objectives Sentinel node mapping (SNM) has replaced lymphadenectomy for staging surgery in apparent early-stage endometrial cancer (EC). Here, we evaluate the long-term survival of three different approaches of nodal assessment in low, intermediate, and high-risk EC.

Methods This is a multi-institutional retrospective study evaluating long-term outcomes (at least 3 years of follow-up) of EC patients having nodal assessment between 2006 and 2016. In order to reduce possible confounding factors, we applied a propensity-matched algorithm.

Results Charts of 940 patients were evaluated: 174 (18.5%), 187 (19.9%), and 579 (61.6%) having SNM, SNM followed by backup lymphadenectomy and lymphadenectomy, respectively. Applying a propensity score matching algorithm (1:1:2) we selected 500 patients: 125 SNM vs. 125 SNM plus backup lymphadenectomy vs. 250 lymphadenectomy. Baseline characteristics of the study population were similar between groups. The prevalence of nodal disease was 14%, 16%, and 12% in patients having SNM, SNM followed by backup lymphadenectomy and lymphadenectomy, respectively. Overall, 19 (7.6%) patients were diagnosed with low volume nodal disease (7 and 12 patients with micrometastasis and isolated tumor cells). The mean (SD) follow-up time was 62 (±11) months. The survival analysis comparing the three techniques did not show statistical differences in terms of disease-free (p=0.750) and overall survival (p=0.899). Similarly, the type of nodal assessment did not impact survival outcomes after stratification on the basis of uterine risk factors.

Conclusions SNM provides similar long-term oncologic outcomes than lymphadenectomy. Further evidence is warranted to assess the prognostic value of low-volume disease detected by ultrastaging and the role of molecular/genomic profiling

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