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The impact of sentinel lymph node sampling versus traditional lymphadenectomy on the survival of patients with stage IIIC endometrial cancer
  1. Dimitrios Nasioudis,
  2. Maureen Byrne,
  3. Emily M Ko,
  4. Robert L Giuntoli II,
  5. Ashley F Haggerty,
  6. Lori Cory,
  7. Sarah H Kim,
  8. Mark A Morgan and
  9. Nawar A Latif
  1. Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
  1. Correspondence to Dr Dimitrios Nasioudis, Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA; dimitrios.nasioudis{at}uphs.upenn.edu

Abstract

Objective To investigate the survival of patients with lymph node positive endometrial carcinoma by type of surgical lymph node assessment.

Methods Patients diagnosed between January 2012 and December 2015 with endometrial carcinoma and uterine confined disease and nodal metastases on final pathology who underwent minimally invasive hysterectomy were identified in the National Cancer Database. Patients who had sentinel lymph node biopsy alone or underwent systematic lymphadenectomy were selected. Overall survival was evaluated following generation of Kaplan–Meier curves and compared with the log rank test. A Cox model was constructed to evaluate survival after controlling for confounders.

Results A total of 1432 patients were identified: 1323 (92.4%) and 109 (7.6%) underwent systematic lymphadenectomy and sentinel lymph node biopsy only, respectively. The rate of adjuvant treatment was comparable between patients who had sentinel lymph node biopsy alone and systematic lymphadenectomy (83.5% vs 86.6%, p=0.39). However, patients who had sentinel lymph node biopsy were less likely to receive chemotherapy alone (13.6% vs 36.6%, p<0.001) and more likely to receive radiation therapy alone (19.8% vs 5.4%, p<0.001) compared with patients who had systematic lymphadenectomy. There was no difference in overall survival between patients who had sentinel lymph node biopsy alone and systematic lymphadenectomy (p=0.27 from log rank test), and 3 year overall survival rates were 82.2% and 79.4%, respectively (p>0.05). After controlling for confounders, there was no difference in survival between the systematic lymphadenectomy and sentinel lymph node biopsy alone groups (hazard ratio 0.82, 95% confidence interval 0.46 to 1.45).

Conclusions Performance of sentinel lymph node biopsy alone was not associated with an adverse impact on survival in patients with lymph node positive endometrial cancer.

  • uterus
  • sentinel lymph node
  • endometrial neoplasms

Data availability statement

Data may be obtained from a third party and are not publicly available. Data can be obtained from the American College of Surgeons.

Statistics from Altmetric.com

Data availability statement

Data may be obtained from a third party and are not publicly available. Data can be obtained from the American College of Surgeons.

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Footnotes

  • DN and MB contributed equally.

  • Contributors DN: conception, data acquisition, data management, statistical analysis, critical analysis, and drafting/final editing. MB: conception, critical analysis, and drafting/final editing. EMK, AFH, LC, SK, MM, and RLG: critical analysis and drafting/final editing. NL: supervision, critical analysis, and drafting/final editing.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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