Introduction/Background According to 2020 ESGO/ESTRO/ESP guidelines, nodal assessment contributes to define high-risk (HR) endometrial cancer (EC) and the choice of adjuvant treatment for high-intermediate risk (HIR) cases. However the growing role of molecular classification in defining prognostic groups and adjuvant therapies might reduce the importance of nodal staging.

Aim of this study was to assess the contribution of nodal staging in defining prognostic groups and adjuvant therapies in EC patients submitted to surgery.

Methodology The study population included 57 women submitted to surgery between 2020 and 2023 at our institution for presumed stage I-II EC, with postoperative diagnosis of HIR (11 patients) and HR (46 patients) disease.

The contribution of nodal staging in the definition of prognostic groups was assessed by reviewing HR patients to identify those without any other feature of such class (non-endometrioid EC, p53abn immunohistochemistry, T3-T4 disease). HIR cases were reviewed to assess which treatment would have been recommended by guidelines if nodal staging data were not available.

Results In 2/46 women (4.3%), allocation to HR class relied exclusively on positive nodal staging.

Among HR patients, chemotherapy (CT) and external-beam radiotherapy (EBRT) were proposed in 40 cases. Without nodal staging, both would have been omitted in 1/40 case (2.5%).

Among HIR patients, CT was proposed in all cases; in pNx patients, unavailability of nodal staging might have caused CT omission in 1/11 case (9.1%), while it probably would not have changed indications to EBRT. In pN0 patients, CT and EBRT would have been considered due to lymphovascular space invasion.

Unavailable nodal staging could globally be related to omission of CT in 2/57 patients (3.5%) and of EBRT in 1/57 patients (1.8%).

Conclusion In this retrospective series, nodal staging had limited impact on definition of HR class and on the choice of adjuvant treatment in the HIR class.

Disclosures The authors declare that they have no know competing financial interest or personal relationships that could have appeared to influence the work reported in this paper. No specific funding was obtained for this study.