Survival of Patients with Serous Uterine Carcinoma Undergoing Sentinel Lymph Node Mapping

Abstract

Objective. The aim of this study was to determine progression-free survival (PFS) in patients with serous uterine carcinoma undergoing sentinel lymph node (SLN) mapping compared with patients undergoing standard lymphadenectomy. Methods. We retrospectively reviewed all uterine cancer patients treated at our institution from 2005 to 2015. Patients were separated into two cohorts: those who underwent SLN mapping at the time of staging (SLN) and those who underwent routine lymphadenectomy (the non-SLN group). SLN mapping was performed according to institutional protocol, incorporating a surgical algorithm and pathologic ultrastaging. Results. Overall, 248 patients were identified—153 SLN mappings and 95 routine lymphadenectomies (pelvic and/or paraaortic lymph node dissection). No significant difference in age or body mass index was observed between the groups (p = 0.08 and p = 0.9, respectively). Minimally invasive surgery was utilized in 117/153 (77%) SLN patients and 30/95 (32%) non-SLN patients (p = <0.001).Stage distribution for the SLN and non-SLN cohorts demonstrated 106/153 (69%) and 59/95 (62%) patients with stage I/II disease, respectively, and 47/153 (31%) and 36/95 (38%) patients with stage III/IV disease, respectively (p = 0.3). The median number of nodes removed was 12 (range, 1–50) in the SLN cohort versus 21 (range, 1–75) in the non-SLN cohort (p = <0.001). Adjuvant chemotherapy alone or with radiation therapy was administered in 122/153 (80%) SLN patients and 79/95 (83%) non-SLN patients; radiotherapy alone was administered in 12/153 (8%) SLN patients and 7/95 (7%) non-SLN patients (p = 0.8). At a median follow-up of 40 months, the 2-year PFS rates were 77% (95% confidence interval [CI], 68–83%) in the SLN group and 71% (95% CI, 61–79%) in the non-SLN group (p = 0.3). Conclusions. Incorporation of the SLN mapping algorithm into the staging of uterine serous cancer is feasible and does not appear to compromise prognosis. PFS in patients with uterine serous carcinoma undergoing SLN mapping, followed by adjuvant therapy, was similar to PFS in patients undergoing standard lymphadenectomy and adjuvant therapy.

Sentinel lymph node mapping and staging in endometrial cancer: A Society of Gynecologic Oncology literature review with consensus recommendations

“…For the SLN versus lymphadenectomy groups, the median nodes removed were 12 (range, 1–50) and 21 (range, 1–75), respectively ( p <0.001). There were no differences in adjuvant therapy or 2-year progression-free survival (77% vs.71%, respectively, p =0.3) [82]. These data suggest the possible safety of the NCCN SLN algorithm in the surgical staging of high-risk histologies, however larger multi-institutional studies with long-term follow up should be performed before lymphadenectomy is abandoned in high-grade disease.…”

“…There was no difference in median progression-free survival between the SLN and lymphadenectomy groups (23 vs. 23.2 months, respectively; p =0.7). High-risk uterine papillary serous carcinoma has also been evaluated in a cohort of 248 patients (153 using the SLN algorithm, 95 with routine lymphadenectomy) [82]. For the SLN versus lymphadenectomy groups, the median nodes removed were 12 (range, 1–50) and 21 (range, 1–75), respectively ( p <0.001).…”

“…Retrospective data support that when high-grade cancers such as carcinosarcoma and uterine papillary serous carcinoma are staged with SLN biopsy, oncologic outcomes appear similar to historical cohorts [81,82]. Pre- and intraoperative assessment for suspicious nodes or extra-uterine disease should be conducted in high-risk (Type II and G3 endometriod) patients, and close adherence to the SLN mapping algorithm is critically important.…”

“…Careful attention to the appearance of the non-SLN per the surgical algorithm is critically important, and suspiciously enlarged nodes should be removed. It is assumed that any lower volume residual disease in non-SLN will be controlled with adjuvant therapy, and the early studies in high risk histology patients discussed in Section V. seem to support this assumption [79, 81, 82]. Nevertheless, more studies with longer followup are desirable to confirm.…”

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

“…We previously compared the efficacy and oncologic outcomes of SLN mapping and selective lymph node dissection for determining lymphatic spread in patients with low-risk and high-risk endometrioid tumors, including those with high-risk histology (including USC) [15e17]. The largest published series on SLN mapping in patients with USC included 248 cases from our institution [12]. We noted 2-year PFS rates of 77% (95% CI, 68e83%) in the SLN group and 71% (95% CI, 61e79%) in the LND group (p ¼ 0.3).…”