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Is there a benefit of lymphadenectomy for overall and recurrence-free survival in type I FIGO IB G1-2 endometrial carcinoma? A retrospective population-based cohort analysis

  • Original Article – Clinical Oncology
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Abstract

Purpose

The recommended therapy for type I FIGO IB endometrial cancer (EC) is hysterectomy and adnexectomy, but the therapeutic benefits of additional pelvic and paraaortic lymph node dissection (LND) are still under discussion. In this study, we retrospectively evaluated overall survival (OAS) and recurrence-free survival (RFS) among patients with type I FIGO IB EC who did undergo systematic or elective lymphadenectomy or none at all.

Methods

We selected 299 individuals from the database of the German Tumor Centre Regensburg who were diagnosed between 1998 and 2015 with endometrial adenocarcinoma of the uterus type I FIGO IB. We applied multivariable Cox regression to the selected patient data and estimated hazard ratios for OAS and RFS against the performed intervention. Further, we carried out risk adjustments with respect to clinicopathological parameters, and performed model selection using conditional stepwise forward selection.

Results

We observed significant benefits of LND in the unadjusted survival analysis; however, we did not confirm this effect in multivariable regression analysis upon risk adjustment. In this case, hazard ratio (HR) for OAS in patients without LND versus patients with LND is reduced to 1.214 (95% CI 0.771–1.911; p = 0.402), HR for RFS is 1.059 (95% CI 0.689–1.626; p = 0.795). Similarly, we were also able to eliminate the statistical benefit of systematic versus elective LND by risk adjustment.

Conclusions

In contrast to previous observations in high-grade EC, our study provides compelling evidence that LND, in particular systematic lymphadenectomy, is not beneficial for patients with type I FIGO IB EC in terms of long-term OAS and RFS.

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Authors and Affiliations

  1. Frauenklinik, Klinikum St. Marien Amberg, Amberg, Germany

    Thomas Papathemelis & Anton Scharl

  2. Tumorzentrum Regensburg, Institut für Qualitätssicherung und Versorgungsforschung der Universität Regensburg, Regensburg, Germany

    Dunja Hassas, Michael Gerken & Monika Klinkhammer-Schalke

  3. Gynäkologisches Universitäts-Krebszentrum Franken, Frauenklinik, Universitätsklinikum Erlangen, CCC Erlangen-EMN, Friedrich-AlexanderUniversität Erlangen, Erlangen, Germany

    Michael P. Lux & Mathias W. Beckmann

  4. Klinik und Poliklinik für RadioOnkologie und Strahlentherapie, Klinikum rechts der Isar, Technische Universität München, Munich, Germany

    Sophia Scharl

Authors
  1. Thomas Papathemelis
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  2. Dunja Hassas
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  3. Michael Gerken
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  4. Monika Klinkhammer-Schalke
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  5. Anton Scharl
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  6. Michael P. Lux
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  7. Mathias W. Beckmann
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Correspondence to Thomas Papathemelis.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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Informed consent was obtained from all individual participants included in the study.

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Papathemelis, T., Hassas, D., Gerken, M. et al. Is there a benefit of lymphadenectomy for overall and recurrence-free survival in type I FIGO IB G1-2 endometrial carcinoma? A retrospective population-based cohort analysis. J Cancer Res Clin Oncol 144, 2019–2027 (2018). https://doi.org/10.1007/s00432-018-2715-4

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  • DOI: https://doi.org/10.1007/s00432-018-2715-4

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