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Survival benefit of pelvic and paraaortic lymphadenectomy in high-grade endometrial carcinoma: a retrospective population-based cohort analysis

  • Original Article – Clinical Oncology
  • Published:
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Abstract

Objective

The standard therapy for high-grade endometrial cancer is surgery but the therapeutic effects of pelvic and paraaortic lymph node dissection (LND) are poorly investigated. In this study, we retrospectively evaluated overall survival, recurrence rates and recurrence-free survival among patients with high-grade type I and II endometrial carcinoma who underwent LND.

Methods

This study included 284 patients who are recorded in the German Tumor Centre Regensburg form 1998 to 2015 and were selected by cancer grading, the absence of secondary tumors, primary surgery including hysterectomy and available follow-up. 244 of the 284 patients in this cohort were unequivocally classified as R0 after resection.

Results

A significantly increased overall survival was observed for systematic LND of 25 or more paraaortic and pelvic lymph nodes versus patients who did not undergo such intervention (p < 0.001) or had elective LND of 1–24 lymph nodes both in univariable (p = 0.016) and multivariable (p = 0.014) analysis. A similar observation was made for recurrence-free survival of patients in the cohort who underwent complete tumor resection (R0). In addition, a reduced cumulative recurrence rate was observed for patients with systematic LND.

Conclusions

Our study provides evidence that the systematic removal of 25 or more pelvic and paraaortic lymph nodes reduces the recurrence rate and that it is beneficial for the long-term overall and recurrence-free survival of patients with high-grade endometrial cancer.

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Authors and Affiliations

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

    Thomas Papathemelis & A. Scharl

  2. Klinik und Poliklinik für Strahlentherapie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93051, Regensburg, Germany

    S. Scharl

  3. Tumorzentrum Regensburg, Institut für Qualitätssicherung und Versorgungsforschung der Universität Regensburg, Am Biopark 9, 93053, Regensburg, Germany

    K. Kronberger, M. Gerken, A. Pauer & M. Klinkhammer-Schalke

Authors
  1. Thomas Papathemelis
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  2. S. Scharl
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  3. K. Kronberger
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  4. M. Gerken
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  5. A. Scharl
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  7. M. Klinkhammer-Schalke
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Corresponding author

Correspondence to Thomas Papathemelis.

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Conflict of interest

Thomas Papathemelis, Sophia Scharl, Karin Kronberger, Michael Gerken, Anton Scharl, Armin Pauer and Monika Klinkhammer-Schalke all declare that they have no conflict of interest.

Human and animal rights

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

Electronic supplementary material

Below is the link to the electronic supplementary material.

432_2017_2508_MOESM1_ESM.tif

Supplementary material Figure S1. Overall survival of patients with stage FIGO I according to lymphadenectomy (TIFF 919 kb)

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Supplementary material Figure S2. Overall survival of patients with stage FIGO II according to lymphadenectomy (TIFF 919 kb)

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Supplementary material Figure S3. Overall survival of patients with stage FIGO III according to lymphadenectomy (TIFF 919 kb)

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Supplementary material Figure S4. Overall survival of patients with type I G3 carcinoma according to lymphadenectomy (TIFF 919 kb)

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Supplementary material Figure S5. Overall survival of patients with carcinosarcoma according to lymphadenectomy (TIFF 919 kb)

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Supplementary material Figure S6. Overall survival of patients with type II carcinoma according to lymphadenectomy (TIFF 919 kb)

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Supplementary material Figure S7. Cumulative rate of recurrences in R0-resected patients according to lymphadenectomy (TIFF 919 kb)

Supplementary material Figure S8. Overall survival of R0-resected patients according to lymphadenectomy (TIFF 919 kb)

Supplementary material Figure S9. Overall survival according to region of lymphadenectomy (TIFF 919 kb)

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Supplementary material Figure S10. Overall survival according to extension of lymphadenectomy in patients with paraaortic and pelvic lymphadenectomy (TIFF 919 kb)

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Supplementary material Figure S11. Overall survival according to extension of lymphadenectomy in patients with pelvic and other lymphadenectomy (TIFF 919 kb)

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Supplementary material Figure S12. Overall survival according to region of lymphadenectomy in patients with systematic lymphadenectomy (TIFF 919 kb)

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Supplementary material Figure S13. Overall survival according to region of lymphadenectomy in patients with elective lymphadenectomy (TIFF 919 kb)

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Papathemelis, T., Scharl, S., Kronberger, K. et al. Survival benefit of pelvic and paraaortic lymphadenectomy in high-grade endometrial carcinoma: a retrospective population-based cohort analysis. J Cancer Res Clin Oncol 143, 2555–2562 (2017). https://doi.org/10.1007/s00432-017-2508-1

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  • DOI: https://doi.org/10.1007/s00432-017-2508-1

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