2022-RA-859-ESGO Long-term survival outcomes in high-risk endometrial cancer patients undergoing sentinel lymph node biopsy vs. lymphadenectomy

Introduction/BackgroundHigh-risk endometrial cancers (HREC) have a poor prognosis, are diagnosed at an advanced stage, and represent 15% of all ECs. In these cases, nodal surgical staging is strongly recommended. Traditionally, pelvic and aortic lymphadenectomy (LMP) is performed with relevant post-operative morbidity. Recently, the introduction of sentinel node biopsy (SLN) also in HREC cases offered a less invasive technique with a high accuracy rate. However, the long-term SLN impact on patients’ survival is not yet known. The study aims to analyze the long-term survival of HREC patients undergoing SLN biopsy versus systematic LMP.MethodologyA retrospective multicentre study was conducted. All HREC patients undergoing surgical treatment were divided into SLN group (group 1) and LMP group (group 2). ESGO/ESTRO/ESP risk class was used to identify HREC patients. A minimum follow-up of 12 months was required for each case.ResultsOf the 177 patients who meet the inclusion criteria, 83 underwent SLN biopsy and 94 cases were staged with systematic LMP. The median follow-up was 36 months (12–46). No significant differences in median age (p=0.439), median BMI (0.268), FIGO stage (p=0.164), and adjuvant therapy (p=0.775) were found in the two groups. Thirty-two recurrences were registered (14 in the SLN and 18 in the LMP group) and 15 cancer-related deaths were reported (8 in the SLN and 7 in the LMP group). One-year OS was 100 vs. 100%, 2-year OS was 94 vs. 95%, and 3-years OS was 92 vs. 93% in groups 1 and 2, respectively (hazard ratio 0.73, Confidence Intervall 95% 0.26–2.00, p=0.54). One-year DFS was 96.4 vs. 97.9%, 2-years DFS was 85.2 vs. 86.7%, and 3-year DFS was 83.4 vs. 83.2 in groups 1 and 2, respectively (hazard ratio 1.01, Confidence Intervall 95% 0.48–2.13, p=0.97).ConclusionSLN biopsy shows long-term survival outcomes superimposable to systematic LMP in HREC patients.