Outcomes of the sentinel lymph node mapping algorithm for patients with locally advanced endometrial carcinoma

Investigate the utilization and oncologic outcomes of the sentinel lymph node algorithm for patients with locally advanced endometrial cancer (involvement of the cervix, vagina, ovary, or parametria) (International Federation of Gynecology and Obstetrics stage II-IIIB).

Patients diagnosed between 2012 and 2015 with endometrial carcinoma who underwent minimally invasive hysterectomy and had endocervical (T2), serosal/adnexal (T3A), or vaginal/parametrial involvement (T3B) and no distant metastases (M0) were identified in the National Cancer Database. Those who underwent sentinel lymph node biopsy (with or without lymphadenectomy) or systematic lymphadenectomy alone (defined as at least 20 lymph nodes removed) were included. Based on pathology reports, the incidence of lymph node metastases was compared with the χ² test. Overall survival was evaluated using Kaplan-Meier curves and compared with the log-rank test. A Cox model was constructed to evaluate survival after controlling for confounders.

A total of 2108 patients were identified; 1786 (84.7%) had systematic lymphadenectomy (of whom 78.1% had para-aortic lymphadenectomy) with a median of 26 lymph nodes removed, while 322 (15.3%) patients underwent sentinel lymph node biopsy. The rate of lymph node metastases was 35.8% in the systematic lymphadenectomy group and 32.6% in the sentinel lymph node biopsy group, P = .27. Rates of adjuvant chemotherapy (59.7% vs 62.4%, p = .36) and radiation therapy (61.5% vs 58.7%, p = .34) were comparable. Patients who had systematic lymphadenectomy were less likely to be discharged within 1 day of surgery (66.4% vs 78.6%, p < .001). There was no overall survival difference between patients who had sentinel lymph node biopsy and those who had systematic lymphadenectomy (p = .60; 4-year overall survival rates were 71.5% and 73.9%, respectively), even after controlling for confounders (HR 1.08, 95% CI 0.82 to 1.41).

Patients with locally advanced endometrial cancer have a high incidence of lymph node metastases. For these patients, sentinel lymph node biopsy is associated with overall survival similar to that of systematic lymphadenectomy.