Three-Year Recurrence-Free Survival in Patients With a Very Low Risk of Endometrial Cancer Who Did Not Undergo Lymph Node Dissection (Tree Retro): A Korean Multicenter Study. Issue 6 (July 2018)

• Record Type: Journal Article
• Authors: Kim, Miseon; Choi, ChelHun; Kim, Kidong; Lim, Myong Cheol; Park, Jeong-Yeol; Hong, Jin Hwa; Lee, Maria; Paek, Jiheum; Seoung, Jungyeob; Lee, Seungho; Lee, Taek Sang
• Is Part Of: International journal of gynecological cancer. Volume 28:Issue 6(2018)
• Publication Date: 2018-07
• Subjects: Endometrial cancer -- Lymph node dissection -- Low risk -- Recurrence-free survival; Generative organs, Female -- Cancer -- Periodicals; 616.99465
• DOI: 10.1097/IGC.0000000000001270
• Languages: English
• ISSNs: 1048-891X

Abstract

Abstract : Objective: Randomized studies have not demonstrated a survival benefit of routine lymph node dissection in early-stage endometrial cancer. Many surgeons nevertheless perform lymph node dissection in all patients with early-stage endometrial cancer. This study aimed to ascertain the survival outcomes of very low-risk endometrial cancer patients (by the Korean Gynecologic Oncology Group [KGOG] criteria) who did not undergo lymph node dissection. Materials and Methods: Medical records of 156 consecutive patients who underwent surgical staging without lymph node dissection were collected from 10 institutions. All patients fulfilled the KGOG criteria: (1) endometrioid corpus cancer diagnosed by preoperative endometrial biopsy, (2) serum cancer antigen-125 level ⩽35 IU/mL, (3) <50% myometrial invasion with no extension beyond the uterine corpus by magnetic resonance imaging (MRI), and (4) no lymph nodes with a short diameter ≥1.0 cm by MRI or computed tomography. Sampling of <5 nodes was allowed at a surgeon's discretion. We evaluated the 3-year recurrence-free survival (RFS) and 5-year overall survival (OS) using the Kaplan-Meier method. Results: The median patient age was 52 years (range, 24–86 years). The median follow-up was 59 months (range, 0–189 months). The 3-year RFS and 5-year OS were 98.6% (95% confidence interval [CI], 96.8%–100.0%) and 98.6% (95% CI, 96.7%–100.0%), respectively. No disease-related mortality occurred. The final pathology report revealed ≥50% myometrial invasion in 29 patients (18.6%) and extension beyond the uterine corpus in 2 patients (1.3%). One patient (0.6%) was diagnosed with lymph node metastasis after lymph node sampling. Eighteen patients (11.5%) received adjuvant therapy after the final pathologic results indicated high risk. Conclusions: Very low-risk patients who did not undergo lymph node dissection had acceptable survival outcomes. Omitting lymph node dissection may be reasonable in patients satisfying the KGOG criteria.