Survival benefits of pelvic lymphadenectomy versus pelvic and para-aortic lymphadenectomy in patients with endometrial cancer

Guo, Weina; Cai, Jing; Li, Min; Wang, Hongbo; Shen, Yi

doi:10.1097/md.0000000000009520

Cited by 23 publications

(21 citation statements)

References 29 publications

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“…The SEPAL study also concluded that stage III–IV patients could benefit from the addition of chemotherapy 6. A recent meta-analysis concluded that para-aortic lymphadenectomy up to the renal vein is associated with favorable survival outcome in intermediate- or high-risk patients compared with pelvic lymph node dissection 7. In the present study, no significant effect of para-aortic lymphadenectomy could be found, but both the number of patients (62) and the average number (5,5) of lymph nodes removed were low, indicating insufficient para-aortic dissection.…”

Section: Discussionmentioning

confidence: 99%

The effect of introducing pelvic lymphadenectomy on survival and recurrence rates in Danish endometrial cancer patients at high risk: a Danish Gynecological Cancer Group study

Ørtoft

Høgdall

Juhl

et al. 2019

Int J Gynecol Cancer

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ObjectivesTo evaluate the rate of survival and recurrence related to the introduction of pelvic lymphadenectomy in Danish high-risk endometrial cancer patients.Study designData on 713 high-risk patients defined as grade 3 with >50% myometrial invasion or serous/clear/undifferentiated carcinomas stage I–IV endometrial cancer patients diagnosed from 2005 to 2012 were retrieved from the Danish Gynecological Cancer Database. Of these, 305 were high-risk stage I. Five year Kaplan-Meier survival estimates and actuarial recurrence rates were calculated, and adjusted Cox used for comparison. Findings were compared with earlier Danish results.ResultsLymphadenectomy in 390 radically operated high-risk patients resulted in upstaging of 31 patients from stage I to IIIC and 19 patients from stage II to IIIC corresponding to 12.8%. Upstaging from stage I to IIIC had a cancer-specific survival of 77%, almost comparable to lymph node-negative high-risk stage I patients (81%). Lymphadenectomy patients had a significant higher overall survival as compared with non-lymph node resected for all patients, but not for stage I patients. Lymphadenectomy, however, did not significantly affect cancer-specific survival, progression-free survival, recurrence rate or risk of local, distant, or lymph node recurrence. When the survival of high-risk stage I patients was compared with earlier Danish results, a small improvement in overall survival (7%) and cancer-specificsurvival (8%) was demonstrated.ConclusionOnly a small number of high-risk patients were upstaged from stage I to III due to lymphadenectomy. These patients showed a surprisingly good survival possibly due to correct stage identification and subsequent relevant adjuvant therapy. However, even though introduction of lymphadenectomy in the Danish high-risk population seems to increase overall survival, no significant change in cancer-specific survival, progression-free survival or recurrence patterns was demonstrated.

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Section: Discussionmentioning

confidence: 99%

The effect of introducing pelvic lymphadenectomy on survival and recurrence rates in Danish endometrial cancer patients at high risk: a Danish Gynecological Cancer Group study

Ørtoft

Høgdall

Juhl

et al. 2019

Int J Gynecol Cancer

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“…11 This result was confirmed by a recent meta-analysis, concluding that para-aortic lymphadenectomy combined with pelvic lymphadenectomy is associated with favorable survival outcomes in patients with endometrial cancer with intermediate or high risk of recurrence compared with pelvic lymphadenectomy alone. 12 Thus, it seems advisable to select only patients at high risk for nodal involvement for complete lymphadenectomy. However, because of the uncertainty of whether and at which stages lymphadenectomy is of therapeutic or diagnostic benefit, extent of lymphadenectomy varies extremely all over the world from no lymphadenectomy at all to resection of all nodes in every patient.…”

Section: Discussionmentioning

confidence: 99%

Influence of Prognostic Factors on Lymph Node Involvement in Endometrial Cancer

Widschwendter

Bauer

Gregorio

et al. 2018

International Journal of Gynecological Cancer

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Lymphovascular space invasion, histological type, and tumor stage are significant predictors of lymph node involvement in endometrial cancer. In patients at high risk of nodal involvement, lymphadenectomy should be performed systematically up to the renal vein. Large and carefully designed prospective studies are needed to evaluate patient cohorts for which a complete lymphadenectomy provides a survival benefit. In the future, the increasing use of sentinel node biopsy may facilitate a more personalized treatment of patients with endometrial cancer.

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“…Patients with combined pelvic and para-aortic lymphadenectomy compared to pelvic lymphadenectomy had a better 5-year OS of 85% vs. 76% (relative risk (RR) 1.13, 95% CI 1.04–0.24, I2 = 57.3%). Subgroup analysis in a formerly published meta-analysis indicated that the positive effect of combined pelvic and para-aortic lymphadenectomy could only be detected in intermediate- or high-risk patients [ 28 ]. No significant difference in OS was found in low-risk EC patients, defined as FIGO stage IA, grade 1–2 and endometrioid histology without lymphovascular space invasion (LVSI).…”

Section: Factors Incorporated In Surgical Stagingmentioning

confidence: 99%

Risk Stratification of Endometrial Cancer Patients: FIGO Stage, Biomarkers and Molecular Classification

Kasius¹,

Pijnenborg

Lindemann

et al. 2021

Cancers

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Endometrial cancer (EC) is the most common gynaecologic malignancy in developed countries. The main challenge in EC management is to correctly estimate the risk of metastases at diagnosis and the risk to develop recurrences in the future. Risk stratification determines the need for surgical staging and adjuvant treatment. Detection of occult, microscopic metastases upstages patients, provides important prognostic information and guides adjuvant treatment. The molecular classification subdivides EC into four prognostic subgroups: POLE ultramutated; mismatch repair deficient (MMRd); nonspecific molecular profile (NSMP); and TP53 mutated (p53abn). How surgical staging should be adjusted based on preoperative molecular profiling is currently unknown. Moreover, little is known whether and how other known prognostic biomarkers affect prognosis prediction independent of or in addition to these molecular subgroups. This review summarizes the factors incorporated in surgical staging (i.e., peritoneal washing, lymph node dissection, omentectomy and peritoneal biopsies), and its impact on prognosis and adjuvant treatment decisions in an era of molecular classification of EC. Moreover, the relation between FIGO stage and molecular classification is evaluated including the current gaps in knowledge and future perspectives.

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Survival benefits of pelvic lymphadenectomy versus pelvic and para-aortic lymphadenectomy in patients with endometrial cancer

Abstract: Supplemental Digital Content is available in the text

Cited by 23 publications

References 29 publications

The effect of introducing pelvic lymphadenectomy on survival and recurrence rates in Danish endometrial cancer patients at high risk: a Danish Gynecological Cancer Group study

The effect of introducing pelvic lymphadenectomy on survival and recurrence rates in Danish endometrial cancer patients at high risk: a Danish Gynecological Cancer Group study

Influence of Prognostic Factors on Lymph Node Involvement in Endometrial Cancer

Risk Stratification of Endometrial Cancer Patients: FIGO Stage, Biomarkers and Molecular Classification

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