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Survival advantage of lymphadenectomy in endometrial cancer

  • Original Article – Clinical Oncology
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Abstract

Background

The lymphadenectomy in the treatment of endometrial cancer is a topic of ongoing debate. The direct comparison between no lymphadenectomy, pelvic lymphadenectomy, and pelvic/para-aortic lymphadenectomy regarding overall survival of patients with endometrial cancer is missing.

Methods

We performed a multicenter, retrospective, registry-based study of 1502 patients with endometrial cancer treated with no lymphadenectomy (n = 697), systemic pelvic lymphadenectomy (n = 543) and systemic pelvic/para-aortic lymphadenectomy (n = 262). The patients were divided into three groups of recurrence risk: low, intermediate, and high. The outcome measure was overall survival.

Results

Median follow-up was 78 months. Lymphadenectomy did not improve overall survival of patients with low risk of recurrence. The survival effect of systemic lymphadenectomy was significant in patients with intermediate and high risk of recurrence. Multivariate analysis showed that both pelvic (HR 0.63, CI 0.38–0.82, p = 0.001) and combination of pelvic/para-aortic lymphadenectomy (HR 0.50, CI 0.43–0.81, p < 0.0001) significantly reduced the mortality risk in patients with intermediate risk compared to the patients who underwent no lymphadenectomy. In patients with high risk, only combined pelvic/para-aortic lymphadenectomy (HR 0.62, CI 0.48–0.82, p = 0.005) was associated with decreased mortality rate compared with no lymphadenectomy. Among patients with intermediate and high risk of recurrence who did not receive any adjuvant therapy, pelvic/para-aortic lymphadenectomy significantly reduced the mortality risk (HR 0.52, CI 0.37–0.73, p < 0.0001) in comparison with no lymphadenectomy. This management was superior to pelvic lymphadenectomy alone. In patients with low risk of recurrence, lymphadenectomy had no effect on overall survival.

Conclusions

Pelvic/para-aortic lymphadenectomy should be performed in all patients with endometrial cancer at intermediate and high risk of recurrence.

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Author notes

    Authors and Affiliations

    1. Department of Obstetrics and Gynecology, Otto-von-Guericke University, G.-Hauptmann Str. 35, 39108, Magdeburg, Germany

      Holm Eggemann, Tanja Ignatov, Katharina Kaiser, Serban Dan Costa & Atanas Ignatov

    2. Institute of Biometry and Medical Informatics, Otto-von-Guericke University, Magdeburg, Germany

      Elke Burger

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    1. Holm Eggemann
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    2. Tanja Ignatov
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    3. Katharina Kaiser
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    4. Elke Burger
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    5. Serban Dan Costa
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    6. Atanas Ignatov
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    Correspondence to Atanas Ignatov.

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    All authors declare that they have no conflict of interest.

    Animal and human rights statement

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

    Ethical standard

    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

    Written informed consent was obtained from all patients before treatment. An additional individual consent for this analysis was not needed.

    Additional information

    Holm Eggemann and Tanja Ignatov have contributed equally to this work.

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    Eggemann, H., Ignatov, T., Kaiser, K. et al. Survival advantage of lymphadenectomy in endometrial cancer. J Cancer Res Clin Oncol 142, 1051–1060 (2016). https://doi.org/10.1007/s00432-015-2109-9

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    • DOI: https://doi.org/10.1007/s00432-015-2109-9

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