Impact of sentinel lymph node biopsy on the therapeutic management of early-stage endometrial cancer: Results of a retrospective multicenter study
Introduction
Endometrial cancer is the most common gynecologic pelvic cancer in both the European Union and the United States. Prognosis is directly linked to histological type and grade and to surgical stage [1], [2], [3], and these factors guide the choice of adjuvant treatments. The prognostic relevance of assessing lymph node (LN) status by lymphadenectomy is, however, still a matter of debate. The recent recommendations for de-escalation of treatment in some patients [4] are based on results from two randomized trials and a meta-analysis, which have proved that pelvic lymphadenectomy has no effect on overall survival (OS) or relapse-free survival (RFS) but is associated with a higher incidence of early and late complications [5], [6], [7]. Nonetheless, 15% of the women whose cancer prognosis is considered good develop a recurrence, and its prognosis, in turn, is not well correlated with conventional histoprognostic factors [8].
Ballester et al. validated the feasibility, detection rates, and accuracy of the SLN mapping and ultrastaging procedure [8] as a possible alternative to pelvic lymphadenectomy in the early stages of endometrial cancer [9]. We report the results of a retrospective multicenter study to assess the impact of this procedure in choosing adjuvant treatment for women with early-stage endometrial cancer.
Section snippets
Patients
Our retrospective multicenter study is based on data from three participating French centers: Tenon Hospital in Paris, Reims University Hospital, and the Georges-François Leclerc Cancer Center in Dijon. Our data include all patients diagnosed with endometrial cancer at one of these hospitals between January 2000 and December 2012. Some of these women (n = 156) were included prospectively when they participated in the SENTI-ENDO protocol (a prospective, multicenter cohort study to assess the
Results
From January 2000 to December 2012, the three participating centers enrolled 494 women, 190 of whom were excluded because of: preoperative diagnosis of type 2 endometrial cancer (n = 87), MRI staging as FIGO stage I high-risk, II, III and IV or indeterminate (n = 92), and preoperative ESMO classification as undetermined (n = 11). This study therefore included 304 women (Fig. 1). The SLN procedure was followed by pelvic lymphadenectomy for 156 women (51.3%); 95 women had pelvic lymphadenectomy alone
Discussion
In this study, SLN mapping and ultrastaging applied to low- and intermediate-risk patients made it possible to detect metastatic LNs three times more often than complete pelvic lymphadenectomy (16.2% versus 5.1%, p = 0.03). Ultrastaging changed the ESMO classification in half of the cases.
The French INCa guidelines issued in 2010 called for therapy de-escalation for patients with a low risk of recurrence (no lymphadenectomy or adjuvant therapy) [4]. These recommendations are based on a Cochrane
Conflicts of interest
The authors declared no conflicts of interest.
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Co-senior author.