Objective We aimed to evaluate the surgical and oncological outcomes of elderly patients with intermediate to high-risk endometrial cancer undergoing staging with sentinel lymph node (SLN) sampling and pelvic lymphadenectomy.
Methods We conducted a retrospective study of elderly (>65-year-old) patients diagnosed with endometrial cancer between December 2007 and August 2017. These patients had been treated at a single center in Montreal, Canada. We compared the surgical and oncological outcomes of three cohorts undergoing surgical staging in non-overlapping eras: 1) lymphadenectomy, 2) lymphadenectomy and SLN sampling, 3) SLN sampling alone. Using life tables, Kaplan-Meier survival curves and log-rank tests, we analyzed 2-year progression-free survival, overall survival, and disease-specific survival.
Results Our study included 278 patients with a median age of 73 years (range; 65–91): 84 (30.2%) underwent lymphadenectomy, 120 (43.2%) underwent SLN sampling with lymphadenectomy, and 74 (26.6%) had SLN sampling alone. The SLN sampling alone group had shorter operative times with a median duration of 199 minutes (range, 75–393) compared with 231 (range, 125–403) and 229 (range, 151–440) minutes in the SLN sampling with lymphadenectomy and lymphadenectomy cohorts; respectively (p<0.001). The SLN sampling alone group also had lower estimated blood loss with a median loss of 20 mL (range, 5–150) vs 25 mL (range, 5–800) and 40 mL (range, 5–400) in the SLN sampling with lymphadenectomy and lymphadenectomy cohorts, respectively (p=0.002). The 2 year overall survival and progression-free survival were not significantly different between the three groups (p=0.45, p=0.51, respectively). On multivariable analysis after adjusting for age, American Society of Anesthesiologists (ASA) score, stage, grade, and lymphovascular space invasion, adding SLN sampling was associated with better overall survival, (HR 0.2, CI [0.1 to 0.6], p=0.006) and progression-free survival (HR 0.5, CI [0.1 to 1.0], p=0.05).
Conclusion Sentinel lymph node-based surgical staging is feasible and associated with better surgical outcomes and comparable oncological outcomes in elderly patients with intermediate and high-risk endometrial cancer.
- Sentinel Lymph Node
Data availability statement
Data are available upon reasonable request.
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Contributors EM was responsible for the study design, statistical analysis, tables and figures, introduction, results interpretation, methods, discussion and he is the guarantor. NE performed the statistical analysis and manuscript editing. CM, SI, TC, AY, DK, OR supported on data collection and editing the manuscript. SS, SL supported the data collection and interpreted results. WG participated in the study design, results interpretation, manuscript editing and the discussion section. LK participated in the study design, abstract, introduction, results interpretation, methods, and the discussion.
Funding This study was supported by grants from the Israel Cancer Research Fund, the Azrieli foundation, the Gloria’s Girls Fund, the Susan and Jonathan Wener Fund, and the Anne-Marie and Mitch Garber Fund.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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