Abstract
Objectives
The role of pelvic lymphadenectomy (LA) in women with stage I endometrial carcinoma
(EC) is controversial. The objective of this study is to investigate the prognostic
impact of LA on survival endpoints in matched cohorts of women with stage I EC solely
of endometrioid histology. Survival endpoints included recurrence-free (RFS), disease-specific
(DSS) and overall survival (OS).
Methods and materials
Patients with FIGO stage I EC who underwent hysterectomy with LA as part of their
surgical staging between 1/1990 and 6/2015 were matched to a similar group that underwent
hysterectomy without lymphadenectomy (NLA), based on stage, grade and adjuvant management.
Univariate and multivariate modeling with Cox regression analysis was carried out
for predictors of survival endpoints.
Results
870 women constituted the study cohort (435 in each group). Median number of dissected
lymph node in the LA group was 9 (range, 5–75). There was no statistically significant
difference between the two groups in regards to 5-year OS (87.2% for LA vs. 91.7%
for NLA) (p = 0.36), DSS 97.7% vs. 98% (p = 0.54) and RFS (93.7% vs. 90% (p = 0.08), respectively. Lymphadenectomy was not a predictor of any of the studied survival
endpoints. On multivariate analysis for the entire cohort, older age, deep myometrial
invasion and higher tumor grade were predictors of worse RFS. For DSS, higher tumor
grade, lower uterine segment (LUS) involvement and FIGO stage IB were significant
predictors of worse outcome. For OS, older age and LUS involvement were the only two
independent predictors for shorter OS.
Conclusions
After matching for FIGO stage, grade and adjuvant management, it appears that lymphadenectomy
in women with stage I EC does not impact survival endpoints.
Keywords
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Article info
Publication history
Published online: December 28, 2016
Accepted:
December 25,
2016
Received in revised form:
December 21,
2016
Received:
November 15,
2016
Identification
Copyright
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