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2022-RA-998-ESGO Intermediate-risk endometrial cancer: isolated tumor cells (ITC) versus node-negative in sentinel lymph node mapping. An international multi-institutional comparative study
  1. Giuseppe Cucinella1,2,
  2. Gabriella Schivardi1,3,
  3. Xun Clare Zhou4,
  4. Mariam Alhilli5,
  5. Sumer Wallace6,
  6. Christoph Wohlmuth7,8,
  7. Glauco Baiocchi9,
  8. Nedim Tokgozoglu10,
  9. Francesco Raspagliesi11,
  10. Alessandro Buda12,13,
  11. Vanna Zanagnolo3,
  12. Ignacio Zapardiel14,
  13. Nisha Jagasia15,
  14. Robert Giuntoli16,
  15. Ariel Glickman17,
  16. Michele Peiretti18,
  17. Maximillian Lanner19,
  18. Enrique Chacon20,
  19. Julian Di Guilmi21,
  20. Augusto Pereira22,
  21. Enora Laas23,
  22. Ami Fishman24,
  23. Caroline C. Nitschmann25,
  24. Katherine Kurnit26,
  25. Kristen Moriarty4,
  26. Amy Joehlin-Price27,5,
  27. Brittany Lees6,
  28. Allan Covens7,
  29. Louise de Brot9,
  30. Cagatay Taskiran10,28,
  31. Giorgio Bogani11,
  32. Tommaso Grassi29,
  33. Cristiana Paniga29,
  34. Francesco Multinu1,3,
  35. Alicia Hernandez-Gutierrez14,
  36. Spyridon Mastroyannis16,
  37. Vito Chiantera2,
  38. Amy L. Weaver30,
  39. Michaela E. McGree30,
  40. Andrea Mariani1 and
  41. Gretchen Glaser1
  1. 1Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN
  2. 2Department of Gynecologic Oncology, University of Palermo, Palermo, Italy
  3. 3IEO, European Institute of Oncology IRCCS, Milan, Italy
  4. 4Hartford HealthCare, Hartford, CT
  5. 5Cleveland Clinic, Cleveland, OH
  6. 6University of Wisconsin School of Medicine and Public Health, Madison, WI
  7. 7Sunnybrook Health Sciences, University of Toronto, Toronto, ON, Canada
  8. 8Department of Obstetrics and Gynecology, Paracelsus Medical University, Salzburg, Austria
  9. 9A.C. Camargo Cancer Center, Sao Paulo, Brazil
  10. 10Turkish Society of Gynecologic Oncology, Istanbul, Turkey
  11. 11Fondazione IRCCS Istituto Nazionale Tumori -Milan, Milan, Italy
  12. 12University of Milano-Bicocca, Monza, Italy
  13. 13Ferrero Hospital, Verduno, Italy
  14. 14La Paz University Hospital-IdiPAZ, Madrid, Spain
  15. 15Mater Hospital Brisbane & Mater Research Institute, University of Queensland, Brisbane, Australia
  16. 16University of Pennsylvania Health System, Philadelphia, PA
  17. 17Barcelona Clinic Hospital, Barcelona, Spain
  18. 18University of Cagliari, Cagliari, Italy
  19. 19Department of Gynaecology, Medical University of Graz, Graz, Austria
  20. 20Clínica Universidad de Navarra, Madrid, Spain
  21. 21Hospital Britanico de Buenos Aires, Buenos Aires, Argentina
  22. 22Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
  23. 23Curie Institute, Paris, France
  24. 24Meir Medical Center, Faculty of Medicine, Tel-Aviv University, Israel
  25. 25Lahey Clinic, Burlington, MA
  26. 26University of Chicago, Chicago, IL
  27. 27Obstetrics and Gynecology Residency Program, University of Connecticut, CT
  28. 28Department of Gynecologic Oncology, Koc University School of Medicine, Istanbul, Turkey
  29. 29San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
  30. 30Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN


Introduction/Background The clinical impact of isolated tumor cells (ITC) (≤0.2 mm) in sentinel lymph nodes (SLN) of endometrial cancer (EC) is unclear. This study compared the recurrence-free survival (RFS) of intermediate-risk EC patients who underwent SLN biopsy and were node-negative vs. those who had ITC.

Methodology Patients with SLN-ITC, between 2012 and 2019, were identified from 21 centers worldwide, while SLN-node-negative patients were identified from Mayo Clinic, Rochester, between 2013 and 2018 and served as comparing group. Only patients with uterine-confined EC and intermediate-risk factors [grade 1 or 2 endometrioid and myometrial invasion (MI) ≥50%; grade 3 endometrioid and MI <50%; non-endometrioid without MI] were included. Adjuvant therapy (ATx) included vaginal brachytherapy (VB), external beam radiation and/or chemotherapy (EBRT±CHT). The primary outcome was non-vaginal recurrence (hematogenous, peritoneal or lymphatic).

Results Of 200 patients included, 74 had ITC and 126 were node-negative. Sixteen patients had a non-vaginal recurrence and the median follow-up for patients without recurrence was 2.9 (IQR, 1.8–3.8) and 2.8 (0.8–4.4) years for the two groups, respectively. Among the 162 patients with ATx (VB only=112; EBRT±CHT=50), there was no significant difference in non-vaginal RFS between ITC vs. node-negative patients [p=0.34; 4-year RFS 84.1% (95% CI, 72.1–98.1%) vs. 91.5% (95% CI, 84.1–99.4%) for 61 ITC vs. 101 node-negative]. However, we observed worse non-vaginal RFS in the subgroup of 32 patients with concurrent ITC and LVSI (p=0.006, figure 1). In particular, the 4-year RFS was 64.6% (95% CI, 43.2–96.8%) in this subgroup compared to 93.3% (95% CI, 81.5–100%) and 91.7% (95% CI, 83.9–100%) for the node-negative patients with and without LVSI, respectively. There were no recurrences among 29 patients with ITC and no LVSI.

Abstract 2022-RA-998-ESGO Figure 1

Non-vaginal recurrence-free survival among patients with intermediate risk factors who received adjuvant therapy, according to nodal status and LVSI

Conclusion Our results on intermediate-risk EC, who received ATx, suggest that the simultaneous presence of ITC and LVSI is associated with a poorer prognosis. Further studies are warranted.

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