Lymphadenectomy, sentinel node mapping plus backup lymphadenectomy and sentinel node mapping alone in low-, intermediate, and high-risk endometrial cancer (555)

Abstract

<b>Objectives:</b> Sentinel node mapping (SNM) has replaced lymphadenectomy for staging surgery in apparent early-stage endometrial cancer (EC). Here, we evaluate the long-term survival of the three different approaches of nodal assessment in low, intermediate, and high-risk EC. <b>Methods:</b> This is a multi-institutional retrospective study evaluating long-term outcomes (at least three years of follow-up) of EC patients having nodal assessment between 2006 and 2016. In order to reduce possible confounding factors, we applied a propensity-matched algorithm. <b>Results:</b> Charts of 940 patients were evaluated, with 174 (18.5%), 187 (19.9%), and 579 (61.6%) having SNM, SNM followed by backup lym- phadenectomy and lymphadenectomy, respectively. Applying a propensity score matching algorithm (1:1:2), we selected 500 patients: 125 SNM versus 125 SNM plus backup lymphadenectomy versus 250 lymphadenectomies. Baseline characteristics of the study population were similar between groups. The prevalence of nodal disease was 14%, 16%, and 12% in patients having SNM, SNM followed by backup lymphadenectomy and lymphadenectomy, respectively. Overall, 19 (7.6%) patients were diagnosed with low volume nodal disease (seven and 12 patients with micrometastasis and isolated tumor cells). The mean (SD) follow-up time was 62 (±11) months. The survival analysis comparing the three techniques did not show statistical differences in terms of disease-free (p=0.750) and overall survival (p=0.899). Similarly, the type of nodal assessment did not impact survival outcomes after stratification on the basis of uterine risk factors. <b>Conclusions:</b> Our study highlighted that SNM provides similar longterm oncologic outcomes to lymphadenectomy. Further evidence is warranted to assess the prognostic value of low volume disease detected by ultrastaging and the role of molecular/genomic profiling.