The impact of sentinel lymph node biopsy alone on survival of patients with endometrial cancer (TRSGO-SLN-007)

Abstract

Introduction/Background: Diagnostic efficacy of sentinel lymph node (SLN) biopsy is proven in many studies in terms of the detection of lymphatic spread in endometrial cancer. However, there are limited data about the effect of SLN biopsy only on survival. The aim of this study was to investigate whether SLN biopsy only compromises oncologic outcomes compared to systematic lymphadenectomy in a large cohort. Methodology: In this multicentric study, records of 564 endometrial cancer patients who underwent surgical staging with either sentinel lymph node biopsy alone or sentinel lymph node biopsy followed by systematic lymphadenectomy with at least 6 months of follow-up time were retrospectively reviewed. The impact of type of lymphadenectomy and histopathologic factors on recurrence, disease-free survival (DFS) and overall survival (OS) were assessed. DFS and OS rates were calculated using Kaplan-Meier method and log-rank test was used to calculate statistical significance between the groups. Cox univariate and multivariate analyses were used to identify prognostic factors for DFS and OS. Result(s): Median follow up time was 28 months (range: 6-130) and 14 (2.5%) of the 21 (3.7%) deaths were due to the disease. 2- and 3-year OS were 98.2% and 97%, respectively. Median time to recurrence was 12.5 months (range: 3-30). Sites of the 42 (7.4%) recurrences were as follows: 12 (28.6%) locoregional, 19 (45.2%) distant, 3 (7.1%) nodal and 8 (19%) more than one site. 2- and 3-year DFS were 93.1% and 92.6%, respectively. While non-endometrioid subtypes (p=0.048), grade 3 histology (p<0.001) and presence of lymphovascular space invasion (LVSI) (p<0.001) were found as independent prognostic factors for decreased DFS, age (p=0.017) and tumor size (p=0.041) were independent factors for shorter OS. Type of lymphadenectomy was not a prognostic factor lymphatic recurrence, DFS and OS. Conclusion: Our study showed that removal of only SLNs was not associated with worse survival compared to systematic lymphadenectomy in endometrial cancer patients. Nodal recurrence rate was also similar between the groups.