Prognostic Role of Lymphadenectomy among Women with Low Grade Lymphovascular Space Invasion-Positive Clinically Uterus Confined Endometrioid Endometrial Cancer

Abstract

Background: Possible therapeutic benefits of lymphadenectomy (LND) in the treatment of endometrial cancer (EC) remain controversial. The present study was undertaken with the aim of investigating the prognostic role of LND in women with clinically confirmed, low-grade, uterus-confined endometrioid EC exhibiting lymphovascular space invasion. Methods: A bicentric retrospective review was conducted for the identification of cases of EC, treated at two gynecologic oncology departments in Turkey. Subsequently, the data of 1811 patients with EC (non-endometrioid, endometrioid, or mixed histology) who had undergone surgery between 2007 and 2016 were analyzed. After extracting data, 37 patients were defined as the study group, and those 37 cases were matched to 74 control patients who had undergone surgery with systematic LND to compare survival. Kaplan-Meier analysis was applied in the process of interpreting data on survival, and variables predicting patient outcomes were identified using Cox proportional hazards regression. Results: Five-year disease-free survival (DFS) rates were 88.2% versus 81.5% (p = 0.985), while overall survival (OS) rates were 91.0% versus 85.7% (p = 0.814) for the study and control groups, respectively. Advanced ages (hazard ratio (HR): 6.69; 95% confidence interval (CI): 1.59–28.09, p = 0.009) and tumors of grade 2 (HR: 3.35; 95% CI: 1.09–10.26, p = 0.034) were found to be independently predictive of decreased OS within the entire cohort. Conclusions: Systematic LND does not have a therapeutic role in the management of low-grade, uterus-confined endometrioid EC with lymphovascular space invasion. There was no difference between the survival outcomes of the two groups considered in this study.

Keywords

• endometrial cancer
• lymphovascular space invasion
• lymphadenectomy