Portal de Periódicos da CAPES

Multicenter study comparing oncologic outcomes between two nodal assessment methods in patients with deeply invasive endometrioid endometrial carcinoma: A sentinel lymph node algorithm versus a comprehensive pelvic and paraaortic lymphadenectomy

2018; Elsevier BV; Volume: 151; Issue: 2 Linguagem: Inglês

10.1016/j.ygyno.2018.08.022

1095-6859

Brooke A. Schlappe, Amy L. Weaver, Jennifer Ducie, Ane Gerda Zahl Eriksson, Sean C. Dowdy, William A. Cliby, Gretchen Glaser, Robert A. Soslow, Kaled M. Alektiar, Vicky Makker, Nadeem R. Abu‐Rustum, Andrea Mariani, Mario M. Leitao,

Uterine Myomas and Treatments

Abstract Objectives To compare oncologic outcomes in the staging of deeply invasive endometrioid endometrial carcinoma (EEC) using a sentinel lymph node algorithm (SLN) versus pelvic and paraaortic lymphadenectomy to the renal veins (LND); to compare outcomes in node-negative cases. Methods At two institutions, patients with deeply invasive (≥50% myometrial invasion) EEC were identified. One institution used LND (2004–2008), the other SLN (2005–2013). FIGO stage IV cases were excluded. Clinical characteristics and follow-up data were recorded. Results 176 patients were identified (LND, 94; SLN, 82). SLN patients were younger ( p = 0.003) and had more LVSI ( p < 0.001). 9.8% in the SLN and 29.8% in the LND cohorts, respectively, received no adjuvant therapy ( p < 0.001). There was no association between type of assessment and recurrence; adjusted hazard ratio (aHR; LND vs. SLN) 0.87 (95%CI 0.40, 1.89) PFS. After controlling for age and adjuvant therapy, there was no association between assessment method and OS (aHR 2.54; 95%CI 0.81, 7.91). The node-negative cohort demonstrated no association between survival and assessment method: aHR 0.69 (95%CI 0.23, 2.03) PFS, 0.81 (95%CI 0.16, 4.22) OS. In the node-negative cohort, neither adjuvant EBRT+/-IVRT (HR 1.63; 95%CI 0.18, 14.97) nor adjuvant chemotherapy+/-EBRT+/-IVRT (HR 0.49; 95%CI 0.11, 2.22) were associated with OS, compared to no adjuvant therapy or IVRT-only. Conclusion Use of an SLN algorithm in deeply invasive EEC does not impair oncologic outcomes. Survival is excellent in node-negative cases, irrespective of assessment method. Adjuvant chemotherapy in node-negative patients does not appear to impact outcome.