Comparison of a Sentinel Lymph Node and a Selective Lymphadenectomy Algorithm in Patients with Endometrioid Endometrial Carcinoma and Limited Myometrial Invasion
Identifieur interne : 003318 ( Pmc/Curation ); précédent : 003317; suivant : 003319Comparison of a Sentinel Lymph Node and a Selective Lymphadenectomy Algorithm in Patients with Endometrioid Endometrial Carcinoma and Limited Myometrial Invasion
Auteurs : Ane Gerda Zahl Eriksson [États-Unis] ; Jen Ducie [États-Unis] ; Narisha Ali [États-Unis] ; Michaela E. Mcgree [États-Unis] ; Amy L. Weaver [États-Unis] ; Giorgio Bogani [Italie] ; William A. Cliby [États-Unis] ; Sean C. Dowdy [États-Unis] ; Jamie N. Bakkum-Gamez [États-Unis] ; Nadeem R. Abu-Rustum [États-Unis] ; Andrea Mariani [États-Unis] ; Mario M. Leitao [États-Unis]Source :
- Gynecologic oncology [ 0090-8258 ] ; 2015.
Abstract
To assess clinicopathologic outcomes between two nodal assessment approaches in patients with endometrioid endometrial carcinoma and limited myoinvasion.
Patients with endometrial cancer at two institutions were reviewed. At one institution, a complete pelvic and para-aortic lymphadenectomy to the renal veins was performed in select cases deemed at risk for nodal metastasis due to grade 3 cancer and/or primary tumor diameter >2 cm (LND cohort). This is a historic approach at this institution. At the other institution, a sentinel lymph node mapping algorithm was used per institutional protocol (SLN cohort). Low risk was defined as endometrioid adenocarcinoma with myometrial invasion <50%. Macrometastasis, micrometastasis, and isolated tumor cells were all considered node-positive.
Of 1135 cases identified, 642 (57%) were managed with an SLN approach and 493 (43%) with an LND approach. Pelvic nodes (PLNs) were removed in 93% and 58% of patients, respectively (P<0.001); para-aortic nodes (PANs) were removed in 14.5% and 50% of patients, respectively (P<0.001). Median number of PLNs removed was 6 and 34, respectively; median number of PANs removed was 5 and 16, respectively (both P<0.001). Metastasis to PLNs was detected in 5.1% and 2.6% of patients, respectively (P=0.03), and to PANs in 0.8% and 1.0%, respectively (P=0.75). The 3-year disease-free survival rates were 94.9% (95%CI, 92.4–97.5) and 96.8% (95%CI, 95.2–98.5), respectively.
Our findings support the use of either strategy for endometrial cancer staging, with no apparent detriment to the SLN algorithm. The clinical significance of disease detected on ultrastaging and the role of adjuvant therapy is yet to be determined.
Url:
DOI: 10.1016/j.ygyno.2015.12.028
PubMed: 26747778
PubMed Central: 4839486
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<author><name sortKey="Abu Rustum, Nadeem R" sort="Abu Rustum, Nadeem R" uniqKey="Abu Rustum N" first="Nadeem R." last="Abu-Rustum">Nadeem R. Abu-Rustum</name>
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<author><name sortKey="Bakkum Gamez, Jamie N" sort="Bakkum Gamez, Jamie N" uniqKey="Bakkum Gamez J" first="Jamie N." last="Bakkum-Gamez">Jamie N. Bakkum-Gamez</name>
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<author><name sortKey="Abu Rustum, Nadeem R" sort="Abu Rustum, Nadeem R" uniqKey="Abu Rustum N" first="Nadeem R." last="Abu-Rustum">Nadeem R. Abu-Rustum</name>
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<country xml:lang="fr">États-Unis</country>
<wicri:regionArea>Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY</wicri:regionArea>
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<wicri:regionArea>Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY</wicri:regionArea>
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<author><name sortKey="Leitao, Mario M" sort="Leitao, Mario M" uniqKey="Leitao M" first="Mario M." last="Leitao">Mario M. Leitao</name>
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<series><title level="j">Gynecologic oncology</title>
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<front><div type="abstract" xml:lang="en"><sec id="S1"><title>Objectives</title>
<p id="P1">To assess clinicopathologic outcomes between two nodal assessment approaches in patients with endometrioid endometrial carcinoma and limited myoinvasion.</p>
</sec>
<sec id="S2"><title>Methods</title>
<p id="P2">Patients with endometrial cancer at two institutions were reviewed. At one institution, a complete pelvic and para-aortic lymphadenectomy to the renal veins was performed in select cases deemed at risk for nodal metastasis due to grade 3 cancer and/or primary tumor diameter >2 cm (LND cohort). This is a historic approach at this institution. At the other institution, a sentinel lymph node mapping algorithm was used per institutional protocol (SLN cohort). Low risk was defined as endometrioid adenocarcinoma with myometrial invasion <50%. Macrometastasis, micrometastasis, and isolated tumor cells were all considered node-positive.</p>
</sec>
<sec id="S3"><title>Results</title>
<p id="P3">Of 1135 cases identified, 642 (57%) were managed with an SLN approach and 493 (43%) with an LND approach. Pelvic nodes (PLNs) were removed in 93% and 58% of patients, respectively (P<0.001); para-aortic nodes (PANs) were removed in 14.5% and 50% of patients, respectively (P<0.001). Median number of PLNs removed was 6 and 34, respectively; median number of PANs removed was 5 and 16, respectively (both P<0.001). Metastasis to PLNs was detected in 5.1% and 2.6% of patients, respectively (P=0.03), and to PANs in 0.8% and 1.0%, respectively (P=0.75). The 3-year disease-free survival rates were 94.9% (95%CI, 92.4–97.5) and 96.8% (95%CI, 95.2–98.5), respectively.</p>
</sec>
<sec id="S4"><title>Conclusions</title>
<p id="P4">Our findings support the use of either strategy for endometrial cancer staging, with no apparent detriment to the SLN algorithm. The clinical significance of disease detected on ultrastaging and the role of adjuvant therapy is yet to be determined.</p>
</sec>
</div>
</front>
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<journal-id journal-id-type="pubmed-jr-id">3932</journal-id>
<journal-id journal-id-type="nlm-ta">Gynecol Oncol</journal-id>
<journal-id journal-id-type="iso-abbrev">Gynecol. Oncol.</journal-id>
<journal-title-group><journal-title>Gynecologic oncology</journal-title>
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<title-group><article-title>Comparison of a Sentinel Lymph Node and a Selective Lymphadenectomy Algorithm in Patients with Endometrioid Endometrial Carcinoma and Limited Myometrial Invasion</article-title>
</title-group>
<contrib-group><contrib contrib-type="author"><name><surname>Eriksson</surname>
<given-names>Ane Gerda Zahl</given-names>
</name>
<degrees>MD</degrees>
<xref ref-type="aff" rid="A1">a</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Ducie</surname>
<given-names>Jen</given-names>
</name>
<degrees>MD</degrees>
<xref ref-type="aff" rid="A1">a</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Ali</surname>
<given-names>Narisha</given-names>
</name>
<degrees>MS, PA-C</degrees>
<xref ref-type="aff" rid="A1">a</xref>
</contrib>
<contrib contrib-type="author"><name><surname>McGree</surname>
<given-names>Michaela E.</given-names>
</name>
<degrees>BS</degrees>
<xref ref-type="aff" rid="A2">b</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Weaver</surname>
<given-names>Amy L.</given-names>
</name>
<degrees>MS</degrees>
<xref ref-type="aff" rid="A2">b</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Bogani</surname>
<given-names>Giorgio</given-names>
</name>
<degrees>MD</degrees>
<xref ref-type="aff" rid="A3">c</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Cliby</surname>
<given-names>William A.</given-names>
</name>
<degrees>MD</degrees>
<xref ref-type="aff" rid="A4">d</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Dowdy</surname>
<given-names>Sean C.</given-names>
</name>
<degrees>MD</degrees>
<xref ref-type="aff" rid="A4">d</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Bakkum-Gamez</surname>
<given-names>Jamie N.</given-names>
</name>
<degrees>MD</degrees>
<xref ref-type="aff" rid="A4">d</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Abu-Rustum</surname>
<given-names>Nadeem R.</given-names>
</name>
<degrees>MD</degrees>
<xref ref-type="aff" rid="A1">a</xref>
<xref ref-type="aff" rid="A5">e</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Mariani</surname>
<given-names>Andrea</given-names>
</name>
<degrees>MD</degrees>
<xref ref-type="aff" rid="A4">d</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Leitao</surname>
<given-names>Mario M.</given-names>
<suffix>Jr</suffix>
</name>
<degrees>MD</degrees>
<xref ref-type="aff" rid="A1">a</xref>
<xref ref-type="aff" rid="A5">e</xref>
</contrib>
</contrib-group>
<aff id="A1"><label>a</label>
Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA</aff>
<aff id="A2"><label>b</label>
Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA</aff>
<aff id="A3"><label>c</label>
Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy</aff>
<aff id="A4"><label>d</label>
Division of Gynecologic Surgery, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA</aff>
<aff id="A5"><label>e</label>
Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA</aff>
<author-notes><corresp id="cor1"><bold>Corresponding Author:</bold>
Mario M. Leitao, Jr., MD, Gynecology Service, Dept of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, Tel: (212) 639-3987, Fax: (212) 366-4436, <email>leitaom@mskcc.org</email>
</corresp>
</author-notes>
<pub-date pub-type="nihms-submitted"><day>8</day>
<month>4</month>
<year>2016</year>
</pub-date>
<pub-date pub-type="epub"><day>31</day>
<month>12</month>
<year>2015</year>
</pub-date>
<pub-date pub-type="ppub"><month>3</month>
<year>2016</year>
</pub-date>
<pub-date pub-type="pmc-release"><day>01</day>
<month>3</month>
<year>2017</year>
</pub-date>
<volume>140</volume>
<issue>3</issue>
<fpage>394</fpage>
<lpage>399</lpage>
<pmc-comment>elocation-id from pubmed: 10.1016/j.ygyno.2015.12.028</pmc-comment>
<abstract><sec id="S1"><title>Objectives</title>
<p id="P1">To assess clinicopathologic outcomes between two nodal assessment approaches in patients with endometrioid endometrial carcinoma and limited myoinvasion.</p>
</sec>
<sec id="S2"><title>Methods</title>
<p id="P2">Patients with endometrial cancer at two institutions were reviewed. At one institution, a complete pelvic and para-aortic lymphadenectomy to the renal veins was performed in select cases deemed at risk for nodal metastasis due to grade 3 cancer and/or primary tumor diameter >2 cm (LND cohort). This is a historic approach at this institution. At the other institution, a sentinel lymph node mapping algorithm was used per institutional protocol (SLN cohort). Low risk was defined as endometrioid adenocarcinoma with myometrial invasion <50%. Macrometastasis, micrometastasis, and isolated tumor cells were all considered node-positive.</p>
</sec>
<sec id="S3"><title>Results</title>
<p id="P3">Of 1135 cases identified, 642 (57%) were managed with an SLN approach and 493 (43%) with an LND approach. Pelvic nodes (PLNs) were removed in 93% and 58% of patients, respectively (P<0.001); para-aortic nodes (PANs) were removed in 14.5% and 50% of patients, respectively (P<0.001). Median number of PLNs removed was 6 and 34, respectively; median number of PANs removed was 5 and 16, respectively (both P<0.001). Metastasis to PLNs was detected in 5.1% and 2.6% of patients, respectively (P=0.03), and to PANs in 0.8% and 1.0%, respectively (P=0.75). The 3-year disease-free survival rates were 94.9% (95%CI, 92.4–97.5) and 96.8% (95%CI, 95.2–98.5), respectively.</p>
</sec>
<sec id="S4"><title>Conclusions</title>
<p id="P4">Our findings support the use of either strategy for endometrial cancer staging, with no apparent detriment to the SLN algorithm. The clinical significance of disease detected on ultrastaging and the role of adjuvant therapy is yet to be determined.</p>
</sec>
</abstract>
<kwd-group><kwd>Endometrial carcinoma</kwd>
<kwd>sentinel lymph node</kwd>
<kwd>sentinel lymph node algorithm</kwd>
<kwd>SLN algorithm</kwd>
<kwd>comprehensive lymphadenectomy</kwd>
<kwd>ultrastaging</kwd>
</kwd-group>
</article-meta>
</front>
</pmc>
</record>
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