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. 2020 Sep;31(5):e64.
doi: 10.3802/jgo.2020.31.e64.

Survival implication of lymphadenectomy in patients surgically treated for apparent early-stage uterine serous carcinoma

Jvan Casarin  1 , Giorgio Bogani  2 , Elisa Piovano  3 , Francesca Falcone  4   5 , Federico Ferrari  6 , Franco Odicino  6 , Andrea Puppo  3 , Ferdinando Bonfiglio  7 , Nicoletta Donadello  8 , Ciro Pinelli  8 , Antonio Simone Laganà  8 , Antonino Ditto  2 , Mario Malzoni  5 , Stefano Greggi  4 , Francesco Raspagliesi  2 , Fabio Ghezzi  8
Affiliations

Survival implication of lymphadenectomy in patients surgically treated for apparent early-stage uterine serous carcinoma

Jvan Casarin et al. J Gynecol Oncol. 2020 Sep.

Abstract

Objective: Uterine serous carcinoma (USC) is a rare highly aggressive disease. In the present study, we aimed to investigate the survival implication of the systematic lymphadenectomy in patients who underwent surgery for apparent early-stage USC.

Methods: Consecutive patients with apparent early-stage USC surgically treated at six Italian referral cancer centers were analyzed. A comparison was made between patients who underwent retroperitoneal staging including at least pelvic lymphadenectomy "LND" vs. those who underwent hysterectomy alone "NO-LND". Baseline, surgical and oncological outcomes were analyzed. Kaplan- Meier curves were calculated for disease-free survival (DFS) and disease-specific survival (DSS). Associations were evaluated with Cox proportional hazard regression and summarized using hazard ratio (HR).

Results: One hundred forty patients were analyzed, 106 LND and 34 NO-LND. NO-LND group (compared to LND group) included older patients (median age, 73 vs.67 years) and with higher comorbidities (median Charlson Comorbidity Index, 6 vs. 5) (p<0.001). No differences in terms of recurrence rate (LND vs. NO-LND, 33.1% vs. 41.4%; p=0.240) were observed. At Cox regression analysis lymphadenectomy did not significantly influence DFS (HR=0.59; 95% confidence interval [CI]=0.32-1.08; p=0.09), and DSS (HR=0.14; 95% CI=0.02-1.21; multivariable analysis p=0.07). Positive node was independently associated with worse DFS (HR=6.22; 95% CI=3.08-12.60; p<0.001) and DSS (HR=5.51; 95% CI=2.31-13.10; p<0.001), while adjuvant chemotherapy was associated with improved DFS (HR=0.38; 95% CI=0.17-0.86; p=0.02) and age was independently associated with worse DSS (HR=1.07; 95% CI=1.02-1.13; p<0.001).

Conclusions: Although lymphadenectomy did not show survival benefits in patients who underwent surgery for apparent early-stage USC, the presence of lymph node metastasis was the main adverse prognostic factors, supporting the prognostic role of the retroperitoneal staging also in this histological subtype.

Keywords: Endometrial Neoplasms; Gynecology; Lymphadenectomy; Survival; Therapeutics.

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Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1
Fig. 1. DFS (A) and DSS (B) were estimated according to the Kaplan-Meier methods. LND vs. NO-LND (left side) and “Adequate” staging vs. “Non-adequate” staging (right side). Significance between the curves was calculated by the log-rank test.
DFS, disease-free survival; DSS, disease specific survival; LND, lymph nodes removed; NO-LND, lymph nodes not removed.
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