Comparison of a sentinel lymph node mapping algorithm and comprehensive lymphadenectomy in the detection of stage IIIC endometrial carcinoma at higher risk for nodal disease
Section snippets
Background
Endometrial cancer is the most common gynecologic malignancy in the United States. Approximately 60,050 women were diagnosed with endometrial cancer in 2016 [1]. Surgical staging has been the standard modality for evaluation of metastatic disease since 1988, when the International Federation of Gynecology and Obstetrics (FIGO) changed the staging system for endometrial cancer from clinical to surgico-pathologic [2]. Important prognostic information can be obtained from surgical staging,
Methods
Institutional Review Board approval and data-transfer permission were obtained at both collaborating institutions. Patients who were surgically staged for endometrial cancer were identified at each center. In this study, we limited our analysis to patients with deeply invasive endometrioid endometrial cancer and serous or clear cell carcinoma. Patients were stratified into two risk groups. Intermediate-risk disease was defined as endometrioid histology, of any grade, with ≥ 50% myometrial
Results
We identified 412 surgically staged patients at the two participating institutions who met the inclusion criteria. Two-hundred and two patients were in the SLN cohort, and 210 were in the LND cohort. Table 1, Table 2 summarize the demographic and pathologic information for patients with endometrioid histology (“intermediate-risk”). Table 3, Table 4 summarize data for patients with serous and clear cell carcinoma of the endometrium (“high-risk”).
Discussion
The role and extent of LND in the surgical staging of endometrial cancer remains controversial. The therapeutic benefit of LND has been debated for years. Some argue that it provides a survival advantage [25]. Kilgore and colleagues argued that systematic LND is essential because it yields important prognostic information and may influence survival. They reported that patients with multi-site LND had improved survival compared to those who had no lymph nodes removed. However, no difference in
Conflict of interest statement
None of the authors declare conflicts of interest.
Funding support
This study was funded in part through the NIH/NCI Support Grant P30 CA008748 (Dr. Soslow, Dr. Abu-Rustum, Dr. Leitao).
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Present address: The Norwegian Radium Hospital, Oslo, Norway.