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Systematic lymphadenectomy for intermediate risk endometrial carcinoma treatment does not improve the oncological outcome
OBJECTIVE: To evaluate the indication and performance of systematic lymphadenectomy (SL) in Stage I endometrioid endometrial carcinoma (EEC), at intermediate risk (FIGO IAG2/G3, IBG1/G2) on recurrence, disease-free survival (DFS) and survival. STUDY DESIGN: 194 women underwent hysterectomies by lapa...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Elsevier
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6687380/ https://www.ncbi.nlm.nih.gov/pubmed/31403112 http://dx.doi.org/10.1016/j.eurox.2019.100020 |
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author | Candido, Elaine C. Rangel Neto, Osmar F. Toledo, Maria Carolina S. Torres, José Carlos C. Cairo, Aurea A.A. Braganca, Joana F. Teixeira, Julio C. |
author_facet | Candido, Elaine C. Rangel Neto, Osmar F. Toledo, Maria Carolina S. Torres, José Carlos C. Cairo, Aurea A.A. Braganca, Joana F. Teixeira, Julio C. |
author_sort | Candido, Elaine C. |
collection | PubMed |
description | OBJECTIVE: To evaluate the indication and performance of systematic lymphadenectomy (SL) in Stage I endometrioid endometrial carcinoma (EEC), at intermediate risk (FIGO IAG2/G3, IBG1/G2) on recurrence, disease-free survival (DFS) and survival. STUDY DESIGN: 194 women underwent hysterectomies by laparotomy, with SL (n = 95) or without SL (n = 99) between 1990 and 2014 was evaluated. Diagnosis period, age, BMI, comorbidities, stage, and adjuvant radiotherapy were analyzed. DFS and cancer-specific survival were analyzed by Kaplan-Meier and log-rank test, and recurrences by Cox regression. RESULTS: SL was performed in 93% (41/44) of women managed before 1998 and decreasing after that (p < 0.001). SL was also more frequent if BMI under 35.0 kg/m(2) (p < 0.001) and in women without comorbidities (p = 0.017). Distribution of age, stage and postoperative radiotherapy were not different between groups. There were 14 recurrences (7.4%), concentrated in the SL group (12 cases) and associated with Stage IAG3 (35.7%, p = 0.009). Longitudinal evaluation exhibited 95% of 5-year cancer-specific survival rate for non-SL group vs. 88% for the SL group (p = 0.039), and DFS rate was 97% for the non-SL group vs. 85% for the SL group (p = 0.004). Cox regression analyses exhibited Stage IAG3 (HR 6.48, IC95% 1.88–22.39; p = 0.003) associated with less DFS. CONCLUSION: SL in surgical staging of EEC at intermediate risk presented no benefits regarding recurrences, DFS, and cancer-specific survival rate when compared to patients not submitted to complete surgical staging. Stage IAG3 had poor prognosis regardless treatment modality. Our results provide further evidence to support the current trend to avoid SL in the surgical approach to selected women. |
format | Online Article Text |
id | pubmed-6687380 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Elsevier |
record_format | MEDLINE/PubMed |
spelling | pubmed-66873802019-08-09 Systematic lymphadenectomy for intermediate risk endometrial carcinoma treatment does not improve the oncological outcome Candido, Elaine C. Rangel Neto, Osmar F. Toledo, Maria Carolina S. Torres, José Carlos C. Cairo, Aurea A.A. Braganca, Joana F. Teixeira, Julio C. Eur J Obstet Gynecol Reprod Biol X Gynaecology: Oncology OBJECTIVE: To evaluate the indication and performance of systematic lymphadenectomy (SL) in Stage I endometrioid endometrial carcinoma (EEC), at intermediate risk (FIGO IAG2/G3, IBG1/G2) on recurrence, disease-free survival (DFS) and survival. STUDY DESIGN: 194 women underwent hysterectomies by laparotomy, with SL (n = 95) or without SL (n = 99) between 1990 and 2014 was evaluated. Diagnosis period, age, BMI, comorbidities, stage, and adjuvant radiotherapy were analyzed. DFS and cancer-specific survival were analyzed by Kaplan-Meier and log-rank test, and recurrences by Cox regression. RESULTS: SL was performed in 93% (41/44) of women managed before 1998 and decreasing after that (p < 0.001). SL was also more frequent if BMI under 35.0 kg/m(2) (p < 0.001) and in women without comorbidities (p = 0.017). Distribution of age, stage and postoperative radiotherapy were not different between groups. There were 14 recurrences (7.4%), concentrated in the SL group (12 cases) and associated with Stage IAG3 (35.7%, p = 0.009). Longitudinal evaluation exhibited 95% of 5-year cancer-specific survival rate for non-SL group vs. 88% for the SL group (p = 0.039), and DFS rate was 97% for the non-SL group vs. 85% for the SL group (p = 0.004). Cox regression analyses exhibited Stage IAG3 (HR 6.48, IC95% 1.88–22.39; p = 0.003) associated with less DFS. CONCLUSION: SL in surgical staging of EEC at intermediate risk presented no benefits regarding recurrences, DFS, and cancer-specific survival rate when compared to patients not submitted to complete surgical staging. Stage IAG3 had poor prognosis regardless treatment modality. Our results provide further evidence to support the current trend to avoid SL in the surgical approach to selected women. Elsevier 2019-04-18 /pmc/articles/PMC6687380/ /pubmed/31403112 http://dx.doi.org/10.1016/j.eurox.2019.100020 Text en © 2019 The Authors http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). |
spellingShingle | Gynaecology: Oncology Candido, Elaine C. Rangel Neto, Osmar F. Toledo, Maria Carolina S. Torres, José Carlos C. Cairo, Aurea A.A. Braganca, Joana F. Teixeira, Julio C. Systematic lymphadenectomy for intermediate risk endometrial carcinoma treatment does not improve the oncological outcome |
title | Systematic lymphadenectomy for intermediate risk endometrial carcinoma treatment does not improve the oncological outcome |
title_full | Systematic lymphadenectomy for intermediate risk endometrial carcinoma treatment does not improve the oncological outcome |
title_fullStr | Systematic lymphadenectomy for intermediate risk endometrial carcinoma treatment does not improve the oncological outcome |
title_full_unstemmed | Systematic lymphadenectomy for intermediate risk endometrial carcinoma treatment does not improve the oncological outcome |
title_short | Systematic lymphadenectomy for intermediate risk endometrial carcinoma treatment does not improve the oncological outcome |
title_sort | systematic lymphadenectomy for intermediate risk endometrial carcinoma treatment does not improve the oncological outcome |
topic | Gynaecology: Oncology |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6687380/ https://www.ncbi.nlm.nih.gov/pubmed/31403112 http://dx.doi.org/10.1016/j.eurox.2019.100020 |
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