2022-RA-859-ESGO Long-term survival outcomes in high-risk endometrial cancer patients undergoing sentinel lymph node biopsy vs. lymphadenectomy

Capozzi, Vito Andrea; Scarpelli, Elisa; Rosati, A.; Vargiu, Virginia; Sozzi, Gabriella; Maglietta, Giuseppe; Armano, Giulia; Butera, Diana; Monfardini, Luciano; Gaiano, Michela; Celora, Gabriella; Barresi, Giuseppe; Finis, Alessandra de; Rotondella, Isabella; Chiàntera, Vito; Cosentino, Francesco; Fanfani, Francesco; Scambia, Giovanni; Ghi, T.; Berretta, Roberto

doi:10.1136/ijgc-2022-esgo.251

Cited by 4 publications

(5 citation statements)

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“…The majority of extrauterine spread in endometrial cancer involves the retroperitoneal lymph nodes. In a retrospective study from Italy on high-risk early-stage patients with endometrial cancer, the observed occurrence was 3.3% in both pelvic and p a r a -a o r t i c l y m p h n o d e s i n t h o s e w h o u n d e r w e n t lymphadenectomy (7). In the evaluation of uncommon lymph node recurrence other than the above sites, an earlier single institutional study of 22 patients with endometrial cancer documented the first recurrence sites to be the inguinal, supraclavicular, and axillary lymph nodes (8).…”

Section: Discussionmentioning

confidence: 97%

Case report: Isolated axillary lymph node metastasis in high-risk endometrial cancer

Chen,

Oo,

2024

Front. Oncol.

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IntroductionThere are risks of developing distant metastases over time for both early- and advanced-stage endometrial cancer. Axillary lymph node metastasis as the first site of recurrence, whether isolated or non-isolated, is uncommon, and there are currently no established treatment guidelines for such cases. This study highlights four cases of recurrent endometrial cancer that manifested axillary lymph node metastasis, providing a comprehensive review of their distinctive clinical behavior and the treatment strategies employed.MethodsWe reviewed and compared four cases of recurrent endometrial cancer that developed axillary lymph node metastasis following adjuvant treatment. Patients’ perspectives were also discussed.ResultsAll four patients had aggressive endometrial histology, including high-grade serous carcinoma and carcinosarcoma. The stages at presentation were stages I and III, with laparotomy or laparoscopy used as the initial surgical approach. Axillary lymph node metastasis was the primary site of recurrence in three cases. Of the three patients with isolated axillary lymph node metastasis, two had long-term survival after aggressive locoregional treatment comprising surgery and radiation.ConclusionAxillary lymph node metastasis as the first site of recurrence is rare, even in high-risk endometrial cancer. In addition to systemic chemotherapy, aggressive locoregional treatment can potentially maximize the chance of long-term disease control.

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Section: Discussionmentioning

confidence: 97%

Case report: Isolated axillary lymph node metastasis in high-risk endometrial cancer

Chen,

Oo,

2024

Front. Oncol.

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“…Whether endometrial cancer patients require lymphadenectomy or other procedures such as sentinel lymph node mapping, pelvic lymphadenectomy alone or combined pelvic and para-aortic lymphadenectomy is still controversial. [16][17][18] Previously, the presence of lymph node metastasis was identified to influence the prognosis and treatment decisions of patients with endometrial cancer. 19 The molecular subtype and preoperative cancer antigen 125> 25 were significantly associated with lymph node metastasis in patients with endometrial cancer.…”

Section: Discussionmentioning

confidence: 99%

Number of Positive Lymph Nodes and Survival in Endometrial Carcinoma: A Proposal for a Modified Staging

Li,

Zhang,

2024

IJWH

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Purpose To construct a new clinical staging system including the number of lymph node metastases to supplement the International Federation of Gynecology and Obstetrics (FIGO) staging for the prognosis of endometrial carcinoma patients. Methods This cohort study retrieved the data of 28,824 patients confirmed as endometrial carcinoma between 2010 and 2015 in the surveillance, epidemiology, and end results (SEER) database. COX risk proportional model was established to evaluate the association between FIGO staging with the all-cause mortality of endometrial carcinoma. The diagnostic value of FIGO staging and the new staging for the mortality of patients were evaluated by receiver operator characteristic curve (ROC). Hazard ratio (HR) and 95% confidence interval (CI) were effect size. Results The 5-year survival rate of all participants was 77.21%. The median follow-up time was 60.00 (60.00,60.00) months. Patients at FIGO staging IB (HR=1.75, 95% CI: 1.62–1.90), FIGO staging II (HR=2.22, 95% CI: 2.00–2.47), FIGO staging IIIA (HR=2.74, 95% CI: 2.43–3.09), FIGO staging IIIB (HR=4.07, 95% CI: 3.48–4.76), FIGO staging IIIC1 (HR=3.84, 95% CI: 3.52–4.20), FIGO staging IIIC2 (HR=4.52, 95% CI: 4.09–4.99), FIGO staging IVA (HR=5.56, 95% CI: 4.58–6.74), and FIGO staging IVB (HR=7.62, 95% CI: 6.94–8.36) were associated with increased risk of all-cause mortality of endometrial carcinoma patients. After adding positive lymph nodes as another covariate in Model 3, the effect on of FIGO staging survival was reduced when the FIGO staging was higher than stage III/IV. The C-index of the new staging 0.781 (95% CI: 0.774–0.787) was higher than FIGO staging 0.776 (95% CI: 0.770–0.783). Conclusion Our new staging using the number of positive lymph nodes supplement to the FIGO staging was superior than the FIGO staging for predicting the prognosis of endometrial cancer patients, which might help more accurately identify endometrial carcinoma patients who were at high risk of mortality and offer timely treatments in these patients.

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“…When these high-risk factors are consistent, the location of the primary tumor is also highly correlated with the location of lymph node metastasis. Capozzi et al [49] revealed Regarding the primary outcome, only the tumor pattern diffused to the whole uterine cavity was statistically associated with SLN uptake on common iliac lymph nodes (OR 2.4,95%CI 1e5.8, p ¼ 0.05).…”

Section: Relationship Between Tumor Location and Lymph Node Metastasi...mentioning

confidence: 98%

Investigating the influence of primary uterine tumor site on pelvic and para-aortic lymph node metastatic pattern and evaluating the risk factors for lymph node metastases in endometrial carcinoma: A retrospective study

Zhang,

Chen,

et al. 2023

Medicine

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To assess the metastatic pattern in pelvic and para-aortic lymph nodes in relation with the primary uterine tumor site and to evaluate risk factors for lymph node metastases. 212 patients with endometrial cancer who underwent surgical treatment from December 2014 to December 2019 were selected. The clinical and pathological data were retrospectively analyzed. The factors and uterine primary tumor site related to lymph node metastasis were analyzed by univariate and multivariate analysis. Among the 212 patients with endometrial cancer, 17 cases had lymph node metastasis, and thus the metastasis rate was 8.02%. Univariate analysis revealed that lymph node metastasis was significantly correlated with Federation of Gynecology and Obstetrics stage, depth of myometrial invasion, tumor size, pathological grade, and lymphovascular space invasion (P < .05) and was not correlated with age, pathological type, and cervical involvement (P > .05). Primary uterine tumor site (fundus, horns, body or lower uterine segment) with or without cervical involvement was associated with different lymph nodes’ metastatic sites. The lymph node metastatic pathways of endometrial cancer mainly include obturator lymph nodes and para-aortic lymph nodes, and skip metastasis may occur; endometrial carcinoma may jump and metastasize to para-aortic lymph nodes, specially when the lesion is located in the uterine fundus and uterine horns (cornua of uterus); there is a significant correlation between the location of lymph node metastasis and the location of primary uterine malignant tumor.

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2022-RA-859-ESGO Long-term survival outcomes in high-risk endometrial cancer patients undergoing sentinel lymph node biopsy vs. lymphadenectomy

Cited by 4 publications

References 0 publications

Case report: Isolated axillary lymph node metastasis in high-risk endometrial cancer

Case report: Isolated axillary lymph node metastasis in high-risk endometrial cancer

Number of Positive Lymph Nodes and Survival in Endometrial Carcinoma: A Proposal for a Modified Staging

Investigating the influence of primary uterine tumor site on pelvic and para-aortic lymph node metastatic pattern and evaluating the risk factors for lymph node metastases in endometrial carcinoma: A retrospective study

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