Survival implication of lymphadenectomy in patients surgically treated for apparent early-stage uterine serous carcinoma

Abstract

Objective Uterine serous carcinoma (USC) is a rare highly aggressive disease. In the present study, we aimed to investigate the survival implication of the systematic lymphadenectomy in patients who underwent surgery for apparent early-stage USC. Methods Consecutive patients with apparent early-stage USC surgically treated at six Italian referral cancer centers were analyzed. A comparison was made between patients who underwent retroperitoneal staging including at least pelvic lymphadenectomy “LND” vs. those who underwent hysterectomy alone “NO-LND”. Baseline, surgical and oncological outcomes were analyzed. Kaplan- Meier curves were calculated for disease-free survival (DFS) and disease-specific survival (DSS). Associations were evaluated with Cox proportional hazard regression and summarized using hazard ratio (HR). Results One hundred forty patients were analyzed, 106 LND and 34 NO-LND. NO-LND group (compared to LND group) included older patients (median age, 73 vs.67 years) and with higher comorbidities (median Charlson Comorbidity Index, 6 vs. 5) (p<0.001). No differences in terms of recurrence rate (LND vs. NO-LND, 33.1% vs. 41.4%; p=0.240) were observed. At Cox regression analysis lymphadenectomy did not significantly influence DFS (HR=0.59; 95% confidence interval [CI]=0.32–1.08; p=0.09), and DSS (HR=0.14; 95% CI=0.02–1.21; multivariable analysis p=0.07). Positive node was independently associated with worse DFS (HR=6.22; 95% CI=3.08–12.60; p<0.001) and DSS (HR=5.51; 95% CI=2.31–13.10; p<0.001), while adjuvant chemotherapy was associated with improved DFS (HR=0.38; 95% CI=0.17–0.86; p=0.02) and age was independently associated with worse DSS (HR=1.07; 95% CI=1.02–1.13; p<0.001). Conclusions Although lymphadenectomy did not show survival benefits in patients who underwent surgery for apparent early-stage USC, the presence of lymph node metastasis was the main adverse prognostic factors, supporting the prognostic role of the retroperitoneal staging also in this histological subtype.

Robotic single-site surgery versus laparoendoscopic single-site surgery in early-stage endometrial cancer: a case-control study.

“…Casarin et al found that systematic lymph node dissection has important survival significance for patients, and the presence of lymph node metastasis was the main adverse prognostic factor [18]. Mean- while, it was found that preoperative imaging techniques such as magnetic resonance imaging (MRI) can improve the accuracy of hysteroscopy biopsy [19].…”

Comprehensive pelvic and paraaortic lymphadenectomy in patients with apparently early stage uterine serous carcinoma – an anachronism?

“…Positive nodes were independently associated with worse disease-free survival (DFS) and disease-specific survival (DSS), while adjuvant chemotherapy significantly improved DFS. However, at Cox regression analysis, lymphadenectomy did not significantly influence DFS (p=0.09) and DSS (hazard ratio=0.14; 95% confidence interval=0.02-1.21; p=0.07) [22]. Only 25 patients (24%) had complete retroperitoneal staging including the removal of both pelvic and para-aortic lymph nodes, while 76% underwent only systematic pelvic LNE [22].…”

“…In the very interesting paper "Survival implication of lymphadenectomy in patients surgically treated for apparent early-stage uterine serous carcinoma" Casarin and colleagues [22] have compiled the data from 140 consecutive patients with apparent early stage serous EC treated at 6 Italian referral centers. One hundred six patients had at least pelvic LNE and 34 had no lymph node dissection.…”

“…However, at Cox regression analysis, lymphadenectomy did not significantly influence DFS (p=0.09) and DSS (hazard ratio=0.14; 95% confidence interval=0.02–1.21; p=0.07) [ 22 ]. Only 25 patients (24%) had complete retroperitoneal staging including the removal of both pelvic and para-aortic lymph nodes, while 76% underwent only systematic pelvic LNE [ 22 ]. Though prognostic factors were significantly worse in the non LNE-group and significantly less adjuvant therapy was used in these patients, no significant survival differences were observed between groups [ 22 ].…”

Endometrial Carcinomas with Intestinal-Type Metaplasia/Differentiation: Does Mismatch Repair System Defects Matter? Case Report and Systematic Review of the Literature

“…Primary mucinous carcinomas of the endometrium comprise 1–9% of all ECs, usually showing an endocervical-type differentiation [ 5 , 6 ]. They are typically well-differentiated with a relatively good prognosis; however, aggressive cases have been reported [ 1 , 7 ].…”