Oncologic outcomes of endometrial cancer in patients with low-volume metastasis in the sentinel lymph nodes: An international multi-institutional study
Khaled Ghoniem 1 , Alyssa M Larish 1 , Giorgia Dinoi 2 , Xun Clare Zhou 3 , Mariam Alhilli 4 , Sumer Wallace 5 , Christoph Wohlmuth 6 , Glauco Baiocchi 7 , Nedim Tokgozoglu 8 , Francesco Raspagliesi 9 , Alessandro Buda 10 , Vanna Zanagnolo 11 , Ignacio Zapardiel 12 , Nisha Jagasia 13 , Robert Giuntoli 2nd 14 , Ariel Glickman 15 , Michele Peiretti 16 , Maximillian Lanner 17 , Enrique Chacon 18 , Julian Di Guilmi 19 , Augusto Pereira 20 , Enora Laas 21 , Ami Fishman 22 , Caroline C Nitschmann 23 , Susan Parker 3 , Amy Joehlin-Price 4 , Brittany Lees 5 , Allan Covens 24 , Louise De Brot 7 , Cagatay Taskiran 25 , Giorgio Bogani 9 , Cristiana Paniga 10 , Francesco Multinu 26 , Alicia Hernandez-Gutierrez 12 , Amy L Weaver 27 , Michaela E McGree 27 , Andrea Mariani 28
Objective: To assess oncologic outcomes in endometrial cancer patients with low-volume metastasis (LVM) in the sentinel lymph nodes (SLNs).
Methods: Patients with endometrial cancer and SLN-LVM (≤2 mm) from December 3, 2009, to December 31, 2018, were retrospectively identified from 22 centers worldwide. Patients with International Federation of Gynecology and Obstetrics (FIGO) stage IV, adnexal involvement, or unknown adjuvant therapy (ATx) were excluded.
Results: Of 247 patients included, 132 had isolated tumor cell (ITC) and 115 had micrometastasis (MM). Overall 4-year recurrence-free survival (RFS) was 77.6% (95% CI, 70.2%-85.9%); median follow-up for patients without recurrence was 29.6 (interquartile range, 19.2-41.5) months.
At multivariate analysis, Non-endometrioid (NE) (HR, 5.00; 95% CI, 2.50-9.99; P < .001), lymphovascular space invasion (LVSI) (HR, 3.26; 95% CI, 1.45-7.31; P = .004), and uterine serosal invasion (USI) (HR, 3.70; 95% CI, 1.44-9.54; P = .007) were independent predictors of recurrence. Among 47 endometrioid ITC patients without ATx, 4-year RFS was 82.6% (95% CI, 70.1%-97.2). Considering 18 ITC patients with endometrioid grade 1 disease, without LVSI, USI, or ATx, only 1 had recurrence (median follow-up, 24.8 months).
Conclusions: In patients with SLN-LVM, NE, LVSI, and USI were independent risk factors for recurrence. Patients with any risk factor had poor prognosis, even when receiving ATx. Patients with ITC and grade 1 endometrioid disease (no LVSI/USI) had favorable prognosis, even without ATx. Further analysis (with more patients and longer follow-up) is needed to assess whether ATx can be withheld in this low-risk subgroup.