Lymph Node Metastasis in Patients With Endometrioid Endometrial Cancer: Overtreatment Is the Main Issue

Karalök, Alper; Turan, Taner; Başaran, Derman; Türkmen, Osman; Kimyon, Gunsu; Tulunay, Gökhan; Taşçı, Tolga

doi:10.1097/igc.0000000000000937

Cited by 21 publications

(16 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…On the contrary, patients who will not benefit from lymphadenectomy must be identified in order to minimize over-treatment and prevent lymphadenectomy-associated serious morbidities such as intraoperative bleeding, deep vein thrombosis, lymphocyst formation, lymphedema of lower extremities, and chylous ascites [ 15 ]. Since over-treatment is an important issue in the surgical management of endometrioid EC currently [ 5 ], a precise balance must be obtained between the desire to prevent over-treatment and the ability to diagnose LN involvement.…”

Section: Discussionmentioning

confidence: 99%

“…Although the rate of LN involvement is approximately 15% in endometrioid EC [ 5 ], 75% of women with EC require systematic LN dissection (LND) when the Mayo criteria are used [ 3 ]. Lefringhouse et al [ 6 ] have recently reported that the Mayo algorithm performed well at identifying EC at high-risk of extra-uterine disease; however, by recommending lymphadenectomy for over two-thirds of their study population.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Comparison of three different risk-stratification models for predicting lymph node involvement in endometrioid endometrial cancer clinically confined to the uterus

et al. 2017

View full text Add to dashboard Cite

ObjectiveTo compare the clinical validity of the Gynecologic Oncology Group-99 (GOG-99), the Mayo-modified and the European Society for Medical Oncology (ESMO)-modified criteria for predicting lymph node (LN) involvement in women with endometrioid endometrial cancer (EC) clinically confined to the uterus.MethodsA total of 625 consecutive women who underwent comprehensive surgical staging for endometrioid EC clinically confined to the uterus were divided into low- and high-risk groups according to the GOG-99, the Mayo-modified, and the ESMO-modified criteria. Lymphovascular space invasion is the cornerstone of risk stratification according to the ESMO-modified criteria. These 3 risk stratification models were compared in terms of predicting LN positivity.ResultsSystematic LN dissection was achieved in all patients included in the study. LN involvement was detected in 70 (11.2%) patients. LN involvement was correctly estimated in 51 of 70 LN-positive patients according to the GOG-99 criteria (positive likelihood ratio [LR+], 3.3; negative likelihood ratio [LR−], 0.4), 64 of 70 LN-positive patients according to the ESMO-modified criteria (LR+, 2.5; LR−, 0.13) and 69 of the 70 LN-positive patients according to the Mayo-modified criteria (LR+, 2.2; LR−, 0.03). The area under curve of the Mayo-modified, the GOG-99 and the ESMO-modified criteria was 0.763, 0.753, and 0.780, respectively.ConclusionThe ESMO-modified classification seems to be the risk-stratification model that most accurately predicts LN involvement in endometrioid EC clinically confined to the uterus. However, the Mayo-modified classification may be an alternative model to achieve a precise balance between the desire to prevent over-treatment and the ability to diagnose LN involvement.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Comparison of three different risk-stratification models for predicting lymph node involvement in endometrioid endometrial cancer clinically confined to the uterus

et al. 2017

View full text Add to dashboard Cite

show abstract

“…While studies tend to point to a lack of benefits of SL in cases of type 1 cancer restricted to the uterine body [[22], [23], [24], [25], [26], [27], [28]], there is no consensus about how to proceed when the EC had an intermediate risk, as the women evaluated here. Longitudinal evaluation of our data exhibited high 5-year survival rate for both groups, although significantly worse for women performed complete surgical staging, including DFS.…”

Section: Commentmentioning

confidence: 98%

“…Another result worth highlighting was the maintenance of the use of adjuvant radiotherapy even in women who underwent SL, which is currently less indicated in cases of negative lymphadenectomy and without associated risk factors, as guided by more recent studies [13,[26], [27], [28], [29], [30], [31]]. In this study, even in the SL group and considering only women without lymph node involvement, 52% received pelvic radiotherapy, although these were performed before 2010.…”

Section: Commentmentioning

confidence: 99%

Systematic lymphadenectomy for intermediate risk endometrial carcinoma treatment does not improve the oncological outcome

Cândido

Neto

Toledo

et al. 2019

European Journal of Obstetrics & Gynecology and Reproductiv

View full text Add to dashboard Cite

Objective To evaluate the indication and performance of systematic lymphadenectomy (SL) in Stage I endometrioid endometrial carcinoma (EEC), at intermediate risk (FIGO IAG2/G3, IBG1/G2) on recurrence, disease-free survival (DFS) and survival. Study design 194 women underwent hysterectomies by laparotomy, with SL (n = 95) or without SL (n = 99) between 1990 and 2014 was evaluated. Diagnosis period, age, BMI, comorbidities, stage, and adjuvant radiotherapy were analyzed. DFS and cancer-specific survival were analyzed by Kaplan-Meier and log-rank test, and recurrences by Cox regression. Results SL was performed in 93% (41/44) of women managed before 1998 and decreasing after that (p < 0.001). SL was also more frequent if BMI under 35.0 kg/m 2 (p < 0.001) and in women without comorbidities (p = 0.017). Distribution of age, stage and postoperative radiotherapy were not different between groups. There were 14 recurrences (7.4%), concentrated in the SL group (12 cases) and associated with Stage IAG3 (35.7%, p = 0.009). Longitudinal evaluation exhibited 95% of 5-year cancer-specific survival rate for non-SL group vs. 88% for the SL group (p = 0.039), and DFS rate was 97% for the non-SL group vs. 85% for the SL group (p = 0.004). Cox regression analyses exhibited Stage IAG3 (HR 6.48, IC95% 1.88–22.39; p = 0.003) associated with less DFS. Conclusion SL in surgical staging of EEC at intermediate risk presented no benefits regarding recurrences, DFS, and cancer-specific survival rate when compared to patients not submitted to complete surgical staging. Stage IAG3 had poor prognosis regardless treatment modality. Our results provide further evidence to support the current trend to avoid SL in the surgical approach to selected women.

show abstract

“…In the absence of sentinel node biopsy, the choice on lymphadenectomy is guided through preoperative risk stratification, most often based on the tentative stage, histotype and grade 27 . The prevalence of lymph node metastases in endometrial cancer is 11-22% [28][29][30] . If the risk of lymph node metastases could be better predicted, many lymphadenectomies could be avoided.…”

Section: List Of Abbreviationsmentioning

confidence: 99%

Ultrasound‐based risk model for preoperative prediction of lymph‐node metastases in women with endometrial cancer: model‐development study

Eriksson

Epstein

Testa

et al. 2020

Ultrasound in Obstet & Gyne

View full text Add to dashboard Cite

Background: Endometrial cancer is the most common gynecological cancer in the industrialized world, constituting 4.5% of all cancer in Swedish women. Standard surgery is hysterectomy and bilateral salpingo-oophorectomy, with or without lymphadenectomy, depending on the estimated risk of lymph node metastases. Adjuvant therapy is given, depending on the estimated risk of adverse outcome. Numerous risk stratification systems guide the choice on lymphadenectomy, but none is associated with a high accuracy. Lymph node metastases are found in 11-22% of women. If they could be accurately predicted, many lymphadenectomies could be avoided. The aim of this thesis was to improve preoperative risk assessment in women with endometrial cancer, with regard to predicting deep (≥ 50%) myometrial invasion (MI), cervical stromal invasion (CSI), lymph node metastases and recurrence or progression.

show abstract

Lymph Node Metastasis in Patients With Endometrioid Endometrial Cancer: Overtreatment Is the Main Issue

Cited by 21 publications

References 26 publications

Comparison of three different risk-stratification models for predicting lymph node involvement in endometrioid endometrial cancer clinically confined to the uterus

Comparison of three different risk-stratification models for predicting lymph node involvement in endometrioid endometrial cancer clinically confined to the uterus

Systematic lymphadenectomy for intermediate risk endometrial carcinoma treatment does not improve the oncological outcome

Ultrasound‐based risk model for preoperative prediction of lymph‐node metastases in women with endometrial cancer: model‐development study

Contact Info

Product

Resources

About