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Abstract
Introduction/Background Sentinel lymph node mapping (SLN) is becoming universally adopted as the method of choice to assess nodal spread in early-stage endometrial cancer, however the oncologic outcomes of this have not been specifically evaluated in patients with UCC. Our objective was to assess oncologic outcomes among patients with uterine confined UCC undergoing SLN versus lymph node dissection (LND).
Methodology Patients who underwent surgical management for newly diagnosed UCC between 10/1996 and 6/2021 were retrospectively identified and allocated to SLN or LND groups. Patients with successful bilateral SLN and backup LND were treated as LND (n=4). Patients with unilateral mapping requiring hemipelvis LND and those with empty nodal packets were excluded from analysis (n=3). Appropriate statistical tests were used.
Results Eighty-nine patients met inclusion criteria:
40 (45%) underwent SLN and 49 (55%) LND. Forty-two (86%) patients in LND underwent paraaortic LND vs 3 (7%) in SLN (p<0.001). Sixty-eight (76%) patients had FIGO-stage I/II, 17 (19%) FIGO-stage III, and 4 (5%) FIGO-stage IV. Age, BMI, FIGO-stage, depth of myoinvasion, lymph-vascular invasion, and washing status did not differ between groups. Thirty-five (88%) patients in SLN received adjuvant therapy and 42(86%) in LND (P=0.8). The adjuvant therapies used were: chemotherapy alone (0% SLN vs 17% LND), radiation alone (34% SLN vs 45% LND), and chemoradiation (66% SLN vs 38% LND) (P=0.01), Median follow-up time was 38 months (range, 2–117) for SLN and 61 months (range, 7–235) for LND. Three-year progression-free survival (PFS) was 79% (SE ± 7%) for SLN and 64% (SE ± 8%) for LND (P=0.1). Three-year overall survival (OS) was 89% (SE ± 6%) for SLN and 83% (SE ± 6%) for LND (P=0.05). On multivariate analysis, only FIGO-stage was found to be associated with decrease in both PFS and OS.
Kaplan-Meier Curve comparing overall survival for SLN vs LND
Conclusion SLN and LND yielded similar oncologic outcomes when used in staging uterine-confined UCC.
Disclosures Dr. Abu-Rustum reports grant funding from GRAIL paid to the institution. Dr. Leitao is an ad-hoc speaker for Intuitive Surgical, Inc., has consulted for Medtronic, and has served on the advisory boards of Ethicon/Johnson & Johnson and Immunogen.