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Systematic lymphadenectomy in early stage endometrial cancer

  • Gynecologic Oncology
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Background

The positive effect of systematic lymphadenectomy on survival of patients with endometrial cancer is a topic of ongoing debate.

Methods

We aimed to investigate whether systemic lymphadenectomy is beneficial for patients with early endometrial cancer. For this purpose, we analyzed a population-based registry with of 2392 women with endometrioid endometrial cancer, stage I and II at intermediate and high risk of recurrence. The primary outcome measure was overall survival.

Results

After exclusions, 868 women were eligible for analysis. Of those, 511 and 357 were categorized as intermediate (pT1A G3 and pT1B G1-2) and high risk (pT1B G3 and pT2 G1-3) early stage endometrial cancer, respectively. Lymphadenectomy was performed in 527 (60.7%) of the cases. Patients in the lymphadenectomy group were significantly younger, presented with more tumors of intermediate or undifferentiated grade and exhibited significantly lower co-morbidity rates and Eastern Cooperative of Oncology Group (ECOG) performance status. Median follow-up was 6.7 years. Recurrence-free survival was not improved by lymphadenectomy in the intermediate and high-risk group of patients. During the follow-up period, 111 (12.8%) women had disease recurrence and 302 (34.8%) died. Systematic lymphadenectomy was associated with significant improvement of overall survival in the pT1A G3 and pT1B G3 patient subgroups. Notably, adjustment for patient age and ECOG status abolished the improvement of overall survival by systematic lymphadenectomy in all groups. Thus, lymphadenectomy did not improve recurrence-free survival in the intermediate risk or the high-risk group of patients

Conclusions

Systematic pelvic and para-aortic lymphadenectomy did not improve the survival of patients with early stage I and II endometrioid endometrial cancer at intermediate and high risk of recurrence.

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Funding

This study was not funded.

Author information

Authors and Affiliations

  1. Department of Gynecology and Obstetrics, University Medical Center Regensburg, Landshuter Str. 65, 93053, Regensburg, Germany

    Atanas Ignatov & Olaf Ortmann

  2. Gynecologic Oncology Unit, Metropolitan Hospital, Athen, Greece

    Stylianos Ivros

  3. Max Planck Institute for Biology of Ageing, Cologne, Germany

    Mihaela Bozukova

  4. Department of Gynecology and Obstetrics, Klinikum St. Marien Amberg, Amberg, Germany

    Thomas Papathemelis

  5. Department of Gynecology and Obstetrics, Klinikum Magdeburg, Magdeburg, Germany

    Holm Eggemann

Authors
  1. Atanas Ignatov
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  2. Stylianos Ivros
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  3. Mihaela Bozukova
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  4. Thomas Papathemelis
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  5. Olaf Ortmann
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  6. Holm Eggemann
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Contributions

AI, carried out the study design and statistical analysis and drafted the manuscript, TP, collected the data and participated in analysis of the clinical data; MB, TP and TI, participated in collecting and analysis of the clinical data and drafting the manuscript; SI and OO, participated in drafting the manuscript and contributed methodological knowhow; HE, participated in designing of the study, analysis of the data and drafting the manuscript. All authors read and approved the final version of the manuscript.

Corresponding author

Correspondence to Atanas Ignatov.

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Conflict of interest

All authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with animals performed by any of the authors. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study before treatment. According to the statement of Research and Ethical Committee, Otto-von-Guericke University, Magdeburg, Germany an additional individual consent was not required for this analysis.

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Ignatov, A., Ivros, S., Bozukova, M. et al. Systematic lymphadenectomy in early stage endometrial cancer. Arch Gynecol Obstet 302, 231–239 (2020). https://doi.org/10.1007/s00404-020-05600-8

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  • DOI: https://doi.org/10.1007/s00404-020-05600-8

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