Objectives
To assess clinicopathologic outcomes between two nodal assessment approaches in patients with endometrioid endometrial carcinoma and limited myoinvasion.
Methods
Patients with endometrial cancer at two institutions were reviewed. At one institution, a complete pelvic and para-aortic lymphadenectomy to the renal veins was performed in select cases deemed at risk for nodal metastasis due to grade 3 cancer and/or primary tumor diameter >2 cm (LND cohort). This is a historic approach at this institution. At the other institution, a sentinel lymph node mapping algorithm was used per institutional protocol (SLN cohort). Low risk was defined as endometrioid adenocarcinoma with myometrial invasion <50%. Macrometastasis, micrometastasis, and isolated tumor cells were all considered node-positive.
Results
Of 1135 cases identified, 642 (57%) were managed with an SLN approach and 493 (43%) with an LND approach. Pelvic nodes (PLNs) were removed in 93% and 58% of patients, respectively (P<0.001); para-aortic nodes (PANs) were removed in 14.5% and 50% of patients, respectively (P<0.001). Median number of PLNs removed was 6 and 34, respectively; median number of PANs removed was 5 and 16, respectively (both P<0.001). Metastasis to PLNs was detected in 5.1% and 2.6% of patients, respectively (P=0.03), and to PANs in 0.8% and 1.0%, respectively (P=0.75). The 3-year disease-free survival rates were 94.9% (95%CI, 92.4–97.5) and 96.8% (95%CI, 95.2–98.5), respectively.
Conclusions
Our findings support the use of either strategy for endometrial cancer staging, with no apparent detriment to the SLN algorithm. The clinical significance of disease detected on ultrastaging and the role of adjuvant therapy is yet to be determined.
Perioperative epidural use was independently associated with improved PFS and OS in these patients. Epidural anesthesia at the time of PDS may be warranted in this setting.
Statistically significant socio-demographic disparities in PDS and survival outcomes were not observed among women with advanced OC treated at this HVC. Increased efforts are needed to centralize care to and increase the diversity of pts treated at HVCs.
Objectives To compare the overall (OS) and disease free (DFS) in young women with early-stage endometrial cancer undergoing hysterectomy with and without ovarian conservation. Methods We conducted a a retrospective study of a prospective mono-centric database. We identified all premenopausal women under 50 years of age with stage I endometrioid adenocarcinoma of the endometrium who underwent hysterectomy from 2008 to 2018. Patients were stratified based on whether they underwent oophorectomy or had ovarian conservation. Results The cohort of 20 women included 5 (25%) who had ovarian conservation and 15 (75%) who underwent oophorectomy. The rate of ovarian conservation was lower during the last decade. There were no statistical difference between the ovarian conservation group and the oophorectomy group in OS and DFS, in a Kaplan-Meier analysis, (respectively, P=0.073 and P=0.200). Conclusions Ovarian conservation does not adversely affect survival for women with early-stage endometrial cancer.
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