Lymphadenectomy and pelvic irradiation in high-risk endometrioid endometrial cancer: a population-based retrospective analysis using the SEER databank

Abstract

Original Research Lymphadenectomy and pelvic irradiation in high-risk endometrioid endometrial cancer: a population-based retrospective analysis using the SEER databank Amr A Soliman1,†, * , Meike Schild-Suhren1,† , Sayed A Mostafa2 , Sarah Antar3 , Ahmed Nezzal3 , Basel ReȠky3 , Onur Güralp1 , Eduard Malik1 1University Women's Hospital, Klinikum Oldenburg, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany. Rahel-Straus-Straße 10, 26133 Oldenburg, Germany 2 Statistics Department, Indiana University, Bloomington, 47405 IN, USA 3Oncology Center Mansura University, Department of Surgical Oncology, University of Mansura, 35516 Mansura, Egypt *Correspondence: amr.soliman@uni-oldenburg.de (Amr A Soliman) † These authors contributed equally. DOI:10.31083/j.ceog.2021.01.2168 This is an open access article under the CC BY 4.0 license (https://creativecommons.org/licenses/by/4.0/). Submitted: May 27, 2020 Revised: September 03, 2020 Accepted: September 04, 2020 Published: February 15, 2021 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 any therapeutic role remains controversial. In this study we aimed to investigate the outcome of current practices by performing a population-based retrospective cohort analysis using the US population-derived freely accessible public Surveillance, Epidemiology and End Results program (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 (MantelCox) testwas used toperform overalland pairwise comparisonsofthe survival distributions. The cohort included 47,463 patients, 10,288 of whom fulfilled high-risk criteria. A higher lymph node yield count was associated with better overall survival, although the removal of more than 40 lymph nodes did not confer any further survival benefit. The application of pelvic irradiation without lymph node status confirmation did not provide a survival benefit. From this analysis, no evidence of a survival benefit associated with lymphadenectomy was found. 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 prognostic and therapeutic value of lymphadenectomy in patients with high-risk endometrioid endometrial cancers. Keywords Endometrial cancer; Lymphadenectomy; High-risk endometrioid endometrial cancer; Pelvic irradiation