Lymphadenectomy and pelvic irradiation in high-risk endometrioid endometrial cancer: A population-based retrospective analysis using the SEER databank
20 September 2018 (online)
The current role of lymphadenectomy in early-stage high-risk endometrioid endometrial cancer is to guide further adjuvant treatment according to lymph node status. Whether the procedure has a therapeutic role remains controversial. We therefore aimed in this study to demonstrate the consequences of current practices on a population-based level.
We performed a population-based retrospective cohort analysis using the freely accessible public SEER database. SEER data from patients with endometrial cancer treated between 2004 and 2012 were accessed online on March 1, 2016. Kaplan-Meier estimators were used to describe the survival distribution and the log-rank (Mantel-Cox) test was used to perform overall and pairwise comparisons of the survival distribution.
The cohort included 47,463 patients, 10,288 of who had high-risk criteria. Increasing lymph node yield count was associated with better overall survival, although the removal of more than 40 lymph nodes did not confer any survival benefit. The application of pelvic irradiation without lymph node status confirmation did not provide a survival benefit.
From this analysis, clear evidence of a survival benefit associated with lymphadenectomy could not be demonstrated. However, the current role lymphadenectomy as a staging and guiding tool for further adjuvant treatment was supported. Well-designed prospective randomized trials are required to conclusively determine the therapeutic value of lymphadenectomy in patients with high-risk endometrioid endometrial cancers.