Sentinel lymph node mapping alone compared to more extensive lymphadenectomy in patients with uterine serous carcinoma

Başaran, Derman; Bruce, Shaina F.; Aviki, Emeline; Mueller, Jennifer J.; Broach, Vance; Cadoo, Karen A.; Soslow, Robert A.; Alektiar, Kaled M.; Abu‐Rustum, Nadeem R.; Leitao, Mario M.

doi:10.1016/j.ygyno.2019.10.005

Cited by 38 publications

(21 citation statements)

References 21 publications

(27 reference statements)

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“…A total of 2,048 articles were screened through the search strategy, and 21 articles were included after full text reading. Four were excluded for low quality assessment score (<6) ( 14 – 17 ), two were excluded for patients overlapping ( 18 , 19 ), thus leaving 15 articles eligible for final analysis ( 7 , 20 – 33 ) ( Figure 1 ). Characteristics of the 15 studies are summarized in Supplement Table S1 .…”

Section: Resultsmentioning

confidence: 99%

Operative and Oncological Outcomes Comparing Sentinel Node Mapping and Systematic Lymphadenectomy in Endometrial Cancer Staging: Meta-Analysis With Trial Sequential Analysis

Huang

Zong

et al. 2021

Front. Oncol.

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ObjectiveTo evaluate the utility of sentinel lymph node mapping (SLN) in endometrial cancer (EC) patients in comparison with lymphadenectomy (LND).MethodsComprehensive search was performed in MEDLINE, EMBASE, CENTRAL, OVID, Web of science databases, and three clinical trials registration websites, from the database inception to September 2020. The primary outcomes covered operative outcomes, nodal assessment, and oncological outcomes. Software Revman 5.3 was used. Trial sequential analysis (TSA) and Grading of Recommendations Assessment, Development, and Evaluation (GRADE) were performed.ResultsOverall, 5,820 EC patients from 15 studies were pooled in the meta-analysis: SLN group (N = 2,152, 37.0%), LND group (N = 3,668, 63.0%). In meta-analysis of blood loss, SLN offered advantage over LND in reducing operation bleeding (I2 = 74%, P<0.01). Z-curve of blood loss crossed trial sequential monitoring boundaries though did not reach TSA sample size. There was no difference between SLN and LND in intra-operative complications (I2 = 7%, P = 0.12). SLN was superior to LND in detecting positive pelvic nodes (P-LN) (I2 = 36%, P<0.001), even in high risk patients (I2 = 36%, P = 0.001). While no difference was observed in detection of positive para-aortic nodes (PA-LN) (I2 = 47%, P = 0.76), even in high risk patients (I2 = 62%, P = 0.34). Analysis showed no difference between two groups in the number of resected pelvic nodes (I2 = 99%, P = 0.26). SLN was not associated with a statistically significant overall survival (I2 = 79%, P = 0.94). There was no difference in progression-free survival between SLN and LND (I2 = 52%, P = 0.31). No difference was observed in recurrence. Based on the GRADE assessment, we considered the quality of current evidence to be moderate for P-LN biopsy, low for items like blood loss, PA-LN positive.ConclusionThe present meta-analysis underlines that SLN is capable of reducing blood loss during operation in regardless of surgical approach with firm evidence from TSA. SLN mapping is more targeted for less node dissection and more detection of positive lymph nodes even in high risk patients with conclusive evidence from TSA. Utility of SLN yields no survival detriment in EC patients.

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Section: Resultsmentioning

confidence: 99%

Operative and Oncological Outcomes Comparing Sentinel Node Mapping and Systematic Lymphadenectomy in Endometrial Cancer Staging: Meta-Analysis With Trial Sequential Analysis

Huang

Zong

et al. 2021

Front. Oncol.

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“…The same histology type was further and thoroughly reviewed by MSKCC in a recent paper published by Basaran et al. ( 118 ). This time, they carefully categorized uterine serous carcinoma patients in January 1996 to December 31, 2017 into SLN only group (79) and LAD without SLN group (166).…”

Section: The Application Of Slnm In Early-stage High-risk Ecmentioning

confidence: 99%

Sentinel Lymph Node Mapping in Endometrial Cancer: A Comprehensive Review

et al. 2021

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Endometrial cancer (EC) is known as a common gynecological malignancy. The incidence rate is on the increase annually. Lymph node status plays a crucial role in evaluating the prognosis and selecting adjuvant therapy. Currently, the patients with high-risk (not comply with any of the following: (1) well-differentiated or moderately differentiated, pathological grade G1 or G2; (2) myometrial invasion< 1/2; (3) tumor diameter < 2 cm are commonly recommended for a systematic lymphadenectomy (LAD). However, conventional LAD shows high complication incidence and uncertain survival benefits. Sentinel lymph node (SLN) refers to the first lymph node that is passed by the lymphatic metastasis of the primary malignant tumor through the regional lymphatic drainage pathway and can indicate the involvement of lymph nodes across the drainage area. Mounting evidence has demonstrated a high detection rate (DR), sensitivity, and negative predictive value (NPV) in patients with early-stage lower risk EC using sentinel lymph node mapping (SLNM) with pathologic ultra-staging. Meanwhile, SLNM did not compromise the patient’s progression-free survival (PFS) and overall survival (OS) with low operative complications. However, the application of SLNM in early-stage high-risk EC patients remains controversial. As revealed by the recent studies, SLNM may also be feasible, effective, and safe in high-risk patients. This review aims at making a systematic description of the progress made in the application of SLNM in the treatment of EC and the relevant controversies, including the application of SLNM in high-risk patients.

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“…Although randomized data supporting this approach are lacking, the rarity of this disease makes accrual to clinical trials challenging. Meanwhile, the relatively high rate of DM despite the use of aggressive adjuvant therapy, even in patients with early-stage disease, highlights the need for additional advances for these patients, such as improved surgical techniques 27 and the use of targeted agents like trastuzumab. 28 Finally, inclusion of these patients in larger randomized trials for endometrial cancer is needed, as has been previously suggested, 29 to help improve treatment strategies for this aggressive disease.…”

Section: Discussionmentioning

confidence: 99%

Combined Adjuvant Chemotherapy and Radiation Therapy Improves Disease-Free Survival for Uterine Serous Cancer

Arden

Marvin

Hong

et al. 2020

Advances in Radiation Oncology

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Purpose Uterine serous carcinoma (USC) is a rare but aggressive endometrial cancer histology. We reviewed outcomes for patients with USC to identify the best adjuvant treatment strategy. Methods and Materials We retrospectively identified 162 patients with The International Federation of Gynecology and Obstetrics (FIGO) stage I-IVA USC treated at our institution. Baseline characteristics, treatment details, clinical outcomes, and toxicity data were recorded. Results Median follow-up was 3.4 years (0.3-26 years). A variety of adjuvant therapy strategies were employed: 14% no adjuvant therapy, 28% radiation alone, 15% chemotherapy alone, and 43% combined chemotherapy and radiation. Distant metastasis was the most common type of recurrence (37% at 5 years). For patients with stage I-IVA disease, there were no significant differences in outcomes by treatment type. For patients with stage I-II disease (70% of the cohort), disease-free survival was significantly higher after chemotherapy (alone or with radiation therapy, P = .005) and after combined chemotherapy and radiation compared with all other treatments ( P = .025). Toxicity outcomes were favorable, with minimal grade 3 and no grade 4 or 5 events. Conclusions Patients with USC experience high rates of recurrence and mortality. Distant metastasis is the most common pattern of failure for all stages. For patients with early-stage disease, combined chemotherapy and radiation improves 5-year disease-free survival compared with either single adjuvant treatment alone or no adjuvant treatment. The relatively large group of patients with USC included in this study may account for our ability to detect this improvement whereas clinical trials have failed to do so, possibly owing to the relatively small percentages of patients with USC enrolled.

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Sentinel lymph node mapping alone compared to more extensive lymphadenectomy in patients with uterine serous carcinoma

Abstract: h i g h l i g h t s Systematic LND showed no survival benefit vs SLN mapping alone in patients with USC. Detection of nodal metastasis is the same in SLN mapping alone vs systematic LND.

Cited by 38 publications

References 21 publications

Operative and Oncological Outcomes Comparing Sentinel Node Mapping and Systematic Lymphadenectomy in Endometrial Cancer Staging: Meta-Analysis With Trial Sequential Analysis

Operative and Oncological Outcomes Comparing Sentinel Node Mapping and Systematic Lymphadenectomy in Endometrial Cancer Staging: Meta-Analysis With Trial Sequential Analysis

Sentinel Lymph Node Mapping in Endometrial Cancer: A Comprehensive Review

Combined Adjuvant Chemotherapy and Radiation Therapy Improves Disease-Free Survival for Uterine Serous Cancer

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