Outcome of Patients with High-Risk Endometrial Cancer Undergoing Sentinel Lymph Node Assessment versus Full Lymphadenectomy (070)

Abstract

Objectives: Sentinel lymph node mapping and dissection (SLN) is endorsed by the National Comprehensive Cancer Network as a recommended surgical staging approach in patients diagnosed with apparent uterine-confined endometrial cancer (EC) of all histologies. While SLN has been validated for use in patients with high-risk histologies, data regarding the oncologic safety of SLN in the management of high-risk EC is limited and inconclusive. The objective of this study was to determine the 3-year progression-free survival (PFS) and overall survival (OS) in patients with high-risk EC who underwent SLN compared to patients who underwent pelvic ± para-aortic lymphadenectomy (LND). Methods: All patients in our healthcare system diagnosed with EC with no radiologic evidence of extra-uterine disease who underwent surgical management between January 1, 2014, and September 1, 2020, were identified, and follow-up data were recorded. SLN was performed in accordance with evidence-based practice, and an SLN algorithm was used. High-risk EC was classified based on hysterectomy specimen pathology demonstrating non-endometrioid histology or FIGO grade 3 endometrioid histology. Patients were excluded if they had more than one primary cancer at the time of diagnosis or if no follow-up records were available. Patients were categorized based on intention to treat. All statistical analyses were performed using SAS version 9.4. Conclusions: Patients with high-risk EC who underwent SLN had no difference in 3-year survival relative to LND; however, the SLN group experienced shorter unadjusted OS. When adjusting for age, adjuvant therapy, and surgical approach, the two methods were found to be similar, with a trend towards worse OS for those who underwent SLN. A randomized control trial comparing SLN versus LND with long-term follow-up for patients with EC of high-risk histologies is necessary. Objectives: Sentinel lymph node mapping and dissection (SLN) is endorsed by the National Comprehensive Cancer Network as a recommended surgical staging approach in patients diagnosed with apparent uterine-confined endometrial cancer (EC) of all histologies. While SLN has been validated for use in patients with high-risk histologies, data regarding the oncologic safety of SLN in the management of high-risk EC is limited and inconclusive. The objective of this study was to determine the 3-year progression-free survival (PFS) and overall survival (OS) in patients with high-risk EC who underwent SLN compared to patients who underwent pelvic ± para-aortic lymphadenectomy (LND). Methods: All patients in our healthcare system diagnosed with EC with no radiologic evidence of extra-uterine disease who underwent surgical management between January 1, 2014, and September 1, 2020, were identified, and follow-up data were recorded. SLN was performed in accordance with evidence-based practice, and an SLN algorithm was used. High-risk EC was classified based on hysterectomy specimen pathology demonstrating non-endometrioid histology or FIGO grade 3 endometrioid histology. Patients were excluded if they had more than one primary cancer at the time of diagnosis or if no follow-up records were available. Patients were categorized based on intention to treat. All statistical analyses were performed using SAS version 9.4. Conclusions: Patients with high-risk EC who underwent SLN had no difference in 3-year survival relative to LND; however, the SLN group experienced shorter unadjusted OS. When adjusting for age, adjuvant therapy, and surgical approach, the two methods were found to be similar, with a trend towards worse OS for those who underwent SLN. A randomized control trial comparing SLN versus LND with long-term follow-up for patients with EC of high-risk histologies is necessary.