Lymph Node Number Predicts the Efficacy of Adjuvant Chemoradiotherapy in Node-Positive Endometrial Cancer Patients

Abstract

This study aimed to evaluate the value of lymph node (LN) number as a predictor for adjuvant treatment in node-positive endometrial cancer. Data of 441 patients diagnosed with International Federation of Gynaecology and Obstetrics (FIGO) stage IIIC endometrial cancer and who underwent adjuvant chemotherapy alone or chemoradiotherapy between 2009 and 2015 from the Taiwan Cancer Registry were reviewed. The patients were stratified based on the number of positive LN as follows: 1, 2–5, and ≥ 6. The overall survival (OS) was analysed using the Kaplan–Meier method and the Cox proportional hazards model. In multivariable analysis, chemoradiotherapy was independently associated with improved OS (hazard ratio [HR]: 0.62, 95% confidence interval [CI]: 0.43–0.90; p = 0.01) compared with chemotherapy alone. Patients with ≥ 6 positive LNs were associated with a worse OS (HR: 2.22, 95% CI: 1.25–3.95; p = 0.006) and those with 2–5 LNs were not associated with a worse OS (HR: 1.56, 95% CI: 0.94–2.59; p = 0.09) compared to patients with one LN. When stratified based on LN number, chemoradiotherapy was found to significantly improve the 5-year OS of patients with ≥ 6 positive LNs compared to chemotherapy alone (35.9% vs. 70.0%, p < 0.001). No significant differences between chemotherapy alone and chemoradiotherapy were observed in 5-year OS among patients with one LN (73.1% vs. 80.8%, p = 0.31) or 2–5 positive LNs (71.4% vs. 75.7%, p = 0.68). Lymph node number may be used to identify node-positive endometrial cancer patients who are likely to have improved OS with intensification of adjuvant therapy.

Adjuvant chemoradiotherapy versus chemotherapy alone in stage III endometrial cancer: A systematic review and meta‐analysis

“…24 Similar results supporting CRT instead of CT alone in stage III EC were reached by several retrospective studies. 6,7,9,[12][13][14][15][25][26][27] The result of this systematic review and metaanalysis supports the hypothesis above. For both OS and RFS, the pooled HRs significantly recommended CRT as the adjuvant therapy for stage III EC.…”

“…During the study selection process, 15 articles were ultimately enrolled, with 11 adopted in the metaanalysis (10 retrospective studies [6][7][8][9][10][11][12][13][14][15] and 1 RCT 16 ) (Figure 1). The clinical characteristics of the patients and methodological quality of the 11 articles in meta-analysis were summarized in Table 1.…”

“…During the study selection process, 15 articles were ultimately enrolled, with 11 adopted in the meta‐analysis (10 retrospective studies 6–15 and 1 RCT 16 ) (Figure 1).…”

“…Interestingly, GOG258 also seemed to be a main source of heterogeneity in subgroup analysis by stage of RFS, which suggested pooled HRs favoring CRT in both stage IIIA-IIIB EC and stage IIIC EC, and was more significant in the latter, at the edge of statistical significance (HR 0.77, 95% CI 0.55-1.09) (Figure S1). Since three of studies included in the meta-analysis did not report regimens of adjuvant therapy properly, 12,14,15 a sensitivity analysis was performed, with those whose adjuvant regimens described properly included. Still, patients administrated by CRT exhibited a survival advantage over those by CT, both on OS and on RFS (Figures S2 and S3).…”

Impact of endometrial sampling technique and biopsy volume on the diagnostic accuracy of endometrial cancer

“…Actually, the adequacy of the EST is a fundamental step for the tailoring of surgical extension, in particularly regarding the type of lymph nodal staging (39). In fact, while for ovarian cancer the open debate regards the different therapeutic surgical strategies to predict and to achieve a complete resection (40)(41)(42)(43)(44), instead, for endometrial, and similarly for vulvar (45) and cervical cancer (46), the current research topic is the validity of sentinel lymph node technique (47)(48)(49).…”