Prognostic impact of lymphadenectomy in uterine serous cancer

Abstract

Objective To estimate the survival impact of lymphadenectomy in women diagnosed with uterine serous cancer.Design Women with a diagnosis of uterine serous cancer were identified from the Surveillance, Epidemiology and End Results Program (SEER) from 1988 to 2007. Only surgically treated women were included.Setting The Surveillance, Epidemiology and End Results Program database provided data from 17 registries.Population The study population comprised 4178 women.Methods Statistical analyses using Student's t-test, Kaplan-Meier survival methods and Cox proportional hazards regression were performed.Main outcome measure Overall survival.Results Three thousand, one hundred and ninety-four (67.7%) women underwent lymphadenectomy. Older women ( ‡65 years) and Caucasian women (relative to Asian) were less likely to have lymphadenectomy (P < 0.001). The prevalence of nodal metastasis in women having lymphadenectomy was 32%. Of the 1997 women who had disease grossly confined to the uterus and underwent lymphadenectomy, 387 (19%) were found to have nodal metastasis. Lymphadenectomy was associated with improved survival; women who underwent lymphadenectomy were 41% (hazard ratio [HR], 0.59; 95% confidence interval [CI], 0.54-0.64; P < 0.001) less likely to die than women who did not have the procedure. Moreover, more extensive lymphadenectomy correlated positively with survival. Compared with women with 1-10 nodes removed, those with more extensive lymphadenectomy (>10 nodes removed) were 26% (HR, 0.74; 95% CI, 0.67-0.83; P < 0.001) less likely to die. The impact of the extent of lymphadenectomy on survival was significant in both node-negative and node-positive women.Conclusion Age and race influenced the prevalence of lymphadenectomy in our cohort. This study suggests that the extent of lymphadenectomy is associated with significant improvement in survival of women with uterine serous cancer.

Multicenter study comparing oncologic outcomes after lymph node assessment via a sentinel lymph node algorithm versus comprehensive pelvic and paraaortic lymphadenectomy in patients with serous and clear cell endometrial carcinoma

“…This survival advantage remained when patients with either grade 3 disease or deep myometrial invasion were treated with postoperative radiation therapy (P ¼ 0.0009) [17]. Mahdi et al performed a review of the Surveillance, Epidemiology, and End Results (SEER) data of 4178 women with serous endometrial cancer and found that any LND, as well as a more extensive LND, were associated with improved 5-year OS, even in patients with negative lymph nodes [18]. The SEPAL trial compared survival following surgical staging with pelvic nodal assessment versus pelvic and paraaortic nodal assessment in a retrospective fashion.…”

Competing risk bias was common in Kaplan–Meier risk estimates published in prominent medical journals

“…Patients Outcome [1] Women with uterine serous cancer surgically treated and with known lymphadenectomy status Overall survival [2] Women between the ages of 15 and 39 years with breast cancer Overall survival [3] Patients with radiographically determined noninvasive lung adenocarcinomas who underwent lobectomy and lymph node …”

“…When censoring occurs, the outcome 4 risk in censored subjects is assumed to be the same as those who remain in the cohort. [1] This 5 assumption is acceptable when subjects are censored because they reach the end of the study 6 follow-up period. However, the assumption that the likelihood of an outcome is the same in 7 patients who have a competing risk event is invalid.…”

Risk-stratification of endometrial carcinomas revisited: A combined preoperative and intraoperative scoring system for a reliable prediction of an advanced disease

“…The rationale of lymph node dissection lies in prognostication, proper triage of patients for adjuvant therapy and, as suggested by cohort and registry-based studies, improved survival of patients with high-risk carcinoma [1][2][3].…”