2022-RA-859-ESGO Long-term survival outcomes in high-risk endometrial cancer patients undergoing sentinel lymph node biopsy vs. lymphadenectomy

Abstract

<h3>Introduction/Background</h3> High-risk endometrial cancers (HREC) have a poor prognosis, are diagnosed at an advanced stage, and represent 15% of all ECs. In these cases, nodal surgical staging is strongly recommended. Traditionally, pelvic and aortic lymphadenectomy (LMP) is performed with relevant post-operative morbidity. Recently, the introduction of sentinel node biopsy (SLN) also in HREC cases offered a less invasive technique with a high accuracy rate. However, the long-term SLN impact on patients’ survival is not yet known. The study aims to analyze the long-term survival of HREC patients undergoing SLN biopsy versus systematic LMP. <h3>Methodology</h3> A retrospective multicentre study was conducted. All HREC patients undergoing surgical treatment were divided into SLN group (group 1) and LMP group (group 2). ESGO/ESTRO/ESP risk class was used to identify HREC patients. A minimum follow-up of 12 months was required for each case. <h3>Results</h3> Of the 177 patients who meet the inclusion criteria, 83 underwent SLN biopsy and 94 cases were staged with systematic LMP. The median follow-up was 36 months (12–46). No significant differences in median age (p=0.439), median BMI (0.268), FIGO stage (p=0.164), and adjuvant therapy (p=0.775) were found in the two groups. Thirty-two recurrences were registered (14 in the SLN and 18 in the LMP group) and 15 cancer-related deaths were reported (8 in the SLN and 7 in the LMP group). One-year OS was 100 vs. 100%, 2-year OS was 94 vs. 95%, and 3-years OS was 92 vs. 93% in groups 1 and 2, respectively (hazard ratio 0.73, Confidence Intervall 95% 0.26–2.00, p=0.54). One-year DFS was 96.4 vs. 97.9%, 2-years DFS was 85.2 vs. 86.7%, and 3-year DFS was 83.4 vs. 83.2 in groups 1 and 2, respectively (hazard ratio 1.01, Confidence Intervall 95% 0.48–2.13, p=0.97). <h3>Conclusion</h3> SLN biopsy shows long-term survival outcomes superimposable to systematic LMP in HREC patients.