ESMO–ESGO–ESTRO consensus conference on endometrial cancer: Diagnosis, treatment and follow-up

BackgroundSentinel node mapping has been proposed to reduce surgical side effects, maintaining the accuracy in nodal status assessment for endometrial cancer.ObjectiveTo investigate the role of one-step nucleic acid amplification assay (OSNA) analysis, in the intra-operative tailoring of full nodal dissection, and to analyze the correlation between the type of sentinel node metastasis and the risk of non-sentinel node metastasis.MethodsSurgical and pathological data were collected from 141 consecutive, clinical stage I patients with endometrial cancer undergoing surgical staging. Patients were excluded if they had previous pelvic or abdominal radiotherapy, chemotherapy, abdominal cancer, pelvic or abdominal lymphadenectomy, or contraindications to indocyanine green. All sentinel nodes were analyzed by OSNA, and full lymphadenectomy was performed in positive cases. Statistical analysis was performed using Χ2 and Fisher's exact test to determine whether any of these characteristics could accurately predict the non-sentinel nodes status in positive sentinel node patients.ResultsA total of 141 patients were included in the analysis. Bilateral sentinel nodes were identified in 104 (73.8%) patients, with a median number of 2 (range 2–6) sentinel nodes per patient. In the remaining 37 patients (26.2%), a unilateral sentinel node was obtained, with a median of 1 (range 1–3) sentinel node per patient. Thirty-three (12.0%) positive nodes were found in 24 (17.0%) patients: micro-metastases and macro-metastases were detected in 22 and 2 patients, respectively. At final pathology, all patients with positive non-sentinel nodes had macro-metastases in the sentinel node, whereas in micro-metastatic sentinel nodes no other positive nodes were found at full lymphadenectomy (p<0.001).ConclusionsOur results showed a correlation between the type of metastasis in the sentinel lymph node (SLN) and the incidence of positive non-SLNs. These data suggest a potential role of OSNA analysis in the surgical tailoring of patients with early endometrial cancer, with the goal of definitive risk stratification and a better individualization of adjuvant therapy.

Section: Discussionmentioning

confidence: 89%

Intra-operative assessment of sentinel lymph node status by one-step nucleic acid amplification assay (OSNA) in early endometrial cancer: a prospective study

Monterossi

Buca

Dinoi

et al. 2019

“…In order to study the intermediate risk group according to the European Society of Medical Oncology, European Society of Gynaecological Oncology, and European Society of Radiotherapy and Oncology classification,4 we first selected 1235 patients with an histological type 1 endometrial cancer on the final pathological results. Histological type 2 endometrial cancer and mixed tumors were excluded.…”

Section: Resultsmentioning

confidence: 99%

“…Histological type 2 endometrial cancer and mixed tumors were excluded. In order to avoid missing intermediate risk endometrial cancer patients defined on pre-operative criteria only, that could have been managed as intermediate or high-intermediate risk patients on the basis of those criteria, we selected patients with pre-operative low-, intermediate-, and high-intermediate risk endometrial cancer according to the post-operative definition of the European Society of Medical Oncology, European Society of Gynaecological Oncology, and European Society of Radiotherapy and Oncology classification 4. After surgery, we based ourselves on the final pathological results to only select the intermediate risk group.…”

Section: Resultsmentioning

confidence: 99%

“…In 2016, the European Society of Medical Oncology, European Society of Gynaecological Oncology, and European Society of Radiotherapy and Oncology established new guidelines for adjuvant treatment following the new post-operative classification:4 patients can be classified as having early-stage endometrial cancer at low, intermediate, high-intermediate or high-risk for recurrence by means of a combination of postoperative histological criteria (ie, depth of myometrial invasion, histological type, grade and lymphovascular space invasion status 4. Adjuvant treatment, including vaginal brachytherapy, external beam radiotherapy, or chemotherapy, is based on post-operative analysis including lymph node involvement.…”

Section: Introductionmentioning

confidence: 99%

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Does lymphadenectomy improve survival in patients with intermediate risk endometrial cancer? A multicentric study from the FRANCOGYN Research Group

Bougherara¹,

Azaïs

Behal

et al. 2018

ObjectiveThe role of lymphadenectomy in intermediate risk endometrial cancer remains uncertain. We evaluated the impact of lymphadenectomy on overall survival and relapse-free survival for patients with intermediate risk endometrial cancer.MethodsWe retrospectively reviewed patients from the FRANCOGYN database with intermediate risk endometrial cancer, based on pre-operative and post-operative criteria (type 1, grade 1–2 tumors with deep (> 50%) myometrial invasion and no lymphovascular space invasion), who received primary surgical treatment between November 2002 and August 2013. We compared overall survival and relapse-free survival between staged and unstaged patients.ResultsFrom 1235 screened patients, we selected 108 patients with intermediate risk endometrial cancer. Eighty-two (75.9%) patients underwent nodal staging (consisting of pelvic +/- para-aortic lymphadenectomy). Among them, 35 (32.4%) had lymph node disease. The median follow-up was 25 months (range 0.4 to 155.0). The overall survival rates were 82.5% for patients staged (CI 64.2 to 91.9) vs 77.9 % for unstaged patients (CI 35.4 to 94.2) (P = 0.73). The relapse-free survival rates were 68.9% for staged patients (CI 51.2 to 81.3) vs 68.8% for unstaged patients (CI 29.1 to 89.3) (P=0.67).ConclusionSystematic nodal staging does not appear to improve overall survival and relapse-free survival for patients with IR EC but could provide information to tailor adjuvant therapy. Sentinel lymph node dissection may be an effective and less invasive alternative staging technique and should provide a future alternative for this population.

“…High-risk: FIGO stage I endometrioid endometrial cancer, grade 3 with myometrial invasion ≥50%; non-endometrioid endometrial cancer; FIGO stage >I. Figure 1 shows risk stratification according to the ESMO-ESGO-ESTRO criteria 12…”

Section: Methodsmentioning

confidence: 99%

Impact of gene-specific germline pathogenic variants on presentation of endometrial cancer in Lynch syndrome

Bogani

Ricci

Vitellaro

et al. 2019

ObjectiveLynch syndrome is a risk factor for developing endometrial carcinoma. Our aim was to evaluate the impact of gene-specific germline pathogenic variants on clinical features of patients affected by endometrial cancer.MethodsPatients with a diagnosis of endometrial cancer and with a germline pathogenic variant in mismatch repair genes were reviewed. Patients were classified on the basis of classes of risk according to the ESGO-ESGO-ESTRO (European Society of Medical Oncology/European Society of Gynaecological Oncology/European Society for Radiotherapy and Oncology) guidelines. One-way analysis of variance (ANOVA) and Kruskal-Wallis test were performed to compare three groups of continuous parametric and non-parametric variables, respectively. χ2 test was used to analyze proportions.ResultsOverall, 68 patients with endometrial cancer and Lynch syndrome were evaluated. Ten (14.7%) patients were excluded because of absence of information about the gene involved in Lynch syndrome, thus leaving 58 (85.3%) patients available for the final analysis. MLH1, MSH2, and MSH6 pathogenic variants were observed in 19 (32.7%), 33 (56.9%), and six (10.3%) patients, respectively. Mean±SD age at endometrial cancer diagnosis was 51±6.4, 43.5±7.4, and 60.3±8.8 years (p=0.0002). Prevalence of non-endometrioid endometrial cancer was 15.7%, 24.2%, and 0% in the MLH1, MSH2, and MSH6 groups, respectively (p=0.345). According to the ESMO-ESGO-ESTRO classification, low, intermediate, and high risk endometrial cancer accounted for 47.3%, 10.5%, and 42.1% of the MLH1 group, 57.6%, 3%, and 39.4% of the MSH2 group, and 50%, 50%m and 0% of the MSH6 group (p=0.009).ConclusionsPatients with MLH1 and MSH2 pathogenic variants are at a higher risk of early onset of endometrial cancer than patients with MSH6 pathogenic variants.