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KMID : 1137020180290010001
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Journal of Gynecologic Oncology
2018 Volume.29 No. 1 p.1 ~ p.1
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Role of lymphadenectomy in intermediate-risk endometrial cancer: a matched-pair study
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Coronado Pluvio J.
Rychlik Agnieszka
Martinez Maestre Maria A.
Baquedano Laura
Fasero Maria
Garcia Arreza Aida
Morales Sara
Lubian Daniel M.
Zapardiel Ignacio
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Abstract
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Objective: To assess the impact of lymph node dissection (LND) on morbidity, survival, and cost for intermediate-risk endometrial cancers (IREC).
Methods: A multicenter retrospective cohort of 720 women with IREC (endometrioid histology with myometrial invasion <50% and grade 3; or myometrial invasion ≥50% and grades 1?2; or cervical involvement and grades 1?2) was carried out. All patients underwent hysterectomy and bilateral salpingo-oophorectomy. A matched pair analysis identified 178 pairs (178 with LND and 178 without it) equal in age, body mass index, co-morbidities, American Society of Anesthesiologist score, myometrial invasion, and surgical approach. Demographic data, pathology results, perioperative morbidity, and survival were abstracted from medical records. Disease-free survival (DFS) and overall survival (OS) was analyzed using Kaplan-Meier curves and multivariate Cox regression analysis. Cost analysis was carried out between both groups.
Results: Both study groups were homogeneous in demographic data and pathologic results. The mean follow-up in patients free of disease was 61.7 months (range, 12.0?275.5). DFS (hazard ratio [HR]=1.34; 95% confidence interval [CI]=0.79?2.28) and OS (HR=0.72; 95% CI=0.42?1.23) were similar in both groups, independently of nodes count. In LND group, positive nodes were found in 10 cases (5.6%). Operating time and late postoperative complications were higher in LND group (p<0.05). Infection rate was significantly higher in no-LND group (p=0.035). There were no statistical differences between both groups regarding operative morbidity and hospital stay. The global cost was similar for both groups.
Conclusion: Systematic LND in IREC has no benefit on survival, although it does not show an increase in perioperative morbidity or global cost.
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KEYWORD
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Endometrial Neoplasms, Lymph Node Excision, Costs and Cost Analysis, Survival, Risk Factors, Morbidity
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