Giorgio Bogani1, Andrea Papadia2, Alessandro Buda3, Jvan Casarin4, Violante Di Donato5, Maria Luisa Gasparri2, Francesco Plotti6, Ciro Pinelli4, Maria Chiara Paderno3, Salvatore Lopez7, Anna Myriam Perrone8, Fabio Barra9, Rocco Guerrisi10, Claudia Brusadelli4, Antonella Cromi4, Debora Ferrari3, Valentina Chiapp7, Mauro Signorelli7, Umberto Leone Roberti Maggiore7, Antonino Ditto7, Innocenza Palaia5, Simone Ferrero11, Pierandrea De Iaco6, Roberto Angioli6, Pierluigi Benedetti Panici5, Fabio Ghezzi4, Fabio Landoni3, Michael D Mueller12, Francesco Raspagliesi7. 1. Gynecological Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Italy. Electronic address: Giorgio.bogani@istitutotumori.mi.it. 2. Department of Obstetrics and Gynecology, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale, University' of Italian Switzerland, Lugano, Switzerland. 3. Gynecology Oncology Surgical Unit, Department of Obstetrics and Gynecology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy. 4. Department of Obstetrics and Gynecology, 'Filippo Del Ponte' Hospital, University of Insubria, Italy. 5. Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, Italy. 6. Department of Obstetrics and Gynecology, University Campus Biomedico of Rome, Rome, Italy. 7. Gynecological Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Italy. 8. Gynecologic Oncology Unit, Sant'Orsola-Malpighi Hospital, 40138 Bologna, Italy. 9. Academic Unit of Obstetrics and Gynaecology, IRCCS Ospedale Policlinico San Martino, Genova, Italy. 10. Department of Obstetrics and Gynecology, 'Filippo Del Ponte' Hospital, University of Insubria, Italy. Electronic address: rocco@guerrisi.it. 11. Academic Unit of Obstetrics and Gynaecology, IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genova, Italy. 12. Department of Obstetrics and Gynecology, University Hospital of Bern and University of Bern, Bern, Switzerland.
Abstract
OBJECTIVE: Sentinel node mapping (SLN) has replaced lymphadenectomy for staging surgery in apparent early-stage low and intermediate risk endometrial cancer (EC). Only limited data about the adoption of SNM in high risk EC is still available. Here, we evaluate the outcomes of high-risk EC undergoing SNM (with or without back-up lymphadenectomy). METHODS: This is a multi-institutional international retrospective study, evaluating data of high-risk (FIGO grade 3 endometrioid EC with myometrial invasion >50% and non-endometrioid histology) EC patients undergoing SNM followed by back-up lymphadenectomy and SNM alone. RESULTS: Chart of consecutive 196 patients were evaluated. The study population included 83 and 113 patients with endometrioid and non-endometrioid EC, respectively. SNM alone and SNM followed by back-up lymphadenectomy were performed in 50 and 146 patients, respectively. Among patients having SNM alone, 14 (28%) were diagnosed with nodal disease. In the group of patients undergoing SNM plus back-up lymphadenectomy 34 (23.2%) were diagnosed with nodal disease via SNM. Back-up lymphadenectomy identified 2 (1%) additional patients with nodal disease (in the para-aortic area). Back-up lymphadenectomy allowed to remove adjunctive positive nodes in 16 (11%) patients. After the adoption of propensity-matched algorithm, we observed that patients undergoing SNM plus back-up lymphadenectomy experienced similar disease-free survival (p = 0.416, log-rank test) and overall survival (p = 0.940, log-rank test) than patients undergoing SLN alone. CONCLUSIONS: Although the small sample size, and the retrospective study design this study highlighted that type of nodal assessment did not impact survival outcomes in high-risk EC. Theoretically, back-up lymphadenectomy would be useful in improving the removal of positive nodes, but its therapeutic value remains controversial. Further prospective evidence is needed.
OBJECTIVE: Sentinel node mapping (SLN) has replaced lymphadenectomy for staging surgery in apparent early-stage low and intermediate risk endometrial cancer (EC). Only limited data about the adoption of SNM in high risk EC is still available. Here, we evaluate the outcomes of high-risk EC undergoing SNM (with or without back-up lymphadenectomy). METHODS: This is a multi-institutional international retrospective study, evaluating data of high-risk (FIGO grade 3 endometrioid EC with myometrial invasion >50% and non-endometrioid histology) EC patients undergoing SNM followed by back-up lymphadenectomy and SNM alone. RESULTS: Chart of consecutive 196 patients were evaluated. The study population included 83 and 113 patients with endometrioid and non-endometrioid EC, respectively. SNM alone and SNM followed by back-up lymphadenectomy were performed in 50 and 146 patients, respectively. Among patients having SNM alone, 14 (28%) were diagnosed with nodal disease. In the group of patients undergoing SNM plus back-up lymphadenectomy 34 (23.2%) were diagnosed with nodal disease via SNM. Back-up lymphadenectomy identified 2 (1%) additional patients with nodal disease (in the para-aortic area). Back-up lymphadenectomy allowed to remove adjunctive positive nodes in 16 (11%) patients. After the adoption of propensity-matched algorithm, we observed that patients undergoing SNM plus back-up lymphadenectomy experienced similar disease-free survival (p = 0.416, log-rank test) and overall survival (p = 0.940, log-rank test) than patients undergoing SLN alone. CONCLUSIONS: Although the small sample size, and the retrospective study design this study highlighted that type of nodal assessment did not impact survival outcomes in high-risk EC. Theoretically, back-up lymphadenectomy would be useful in improving the removal of positive nodes, but its therapeutic value remains controversial. Further prospective evidence is needed.
Authors: William A Zammarrelli; Michelle Greenman; Eric Rios-Doria; Katie Miller; Vance Broach; Jennifer J Mueller; Emeline Aviki; Kaled M Alektiar; Robert A Soslow; Lora H Ellenson; Vicky Makker; Nadeem R Abu-Rustum; Mario M Leitao Journal: Gynecol Oncol Date: 2022-02-26 Impact factor: 5.304
Authors: Giorgio Bogani; Isabelle Ray-Coquard; Nicole Concin; Natalie Y L Ngoi; Philippe Morice; Takayuki Enomoto; Kazuhiro Takehara; Hannelore Denys; Remi A Nout; Domenica Lorusso; Michelle M Vaughan; Marta Bini; Masashi Takano; Diane Provencher; Alice Indini; Satoru Sagae; Pauline Wimberger; Robert Póka; Yakir Segev; Se Ik Kim; Francisco J Candido Dos Reis; Salvatore Lopez; Andrea Mariani; Mario M Leitao; Francesco Raspagliesi; Pieluigi Benedetti Panici; Violante Di Donato; Ludovico Muzii; Nicoletta Colombo; Giovanni Scambia; Sandro Pignata; Bradley J Monk Journal: Gynecol Oncol Date: 2021-04-30 Impact factor: 5.304
Authors: Doris Mangiaracina Benbrook; James Randolph Sanders Hocker; Katherine Marie Moxley; Jay S Hanas Journal: Int J Mol Sci Date: 2022-03-18 Impact factor: 5.923