The Added Value of Sentinel Node Mapping in Endometrial Cancer

Study Objective To evaluate long-term oncological outcomes and the added value of sentinel lymph node sampling (SLN) compared to pelvic lymph node dissection (LND) in patients with endometrial cancer. Design During the evaluation phase of SLN for endometrial cancer, we performed LND and SLN and retrospectively compared the oncologic outcome with the immediate non-overlapping historical era during which patients underwent LND. Setting Tertiary gynecology oncology center. Patients or Participants From 2007 to 2010, 193 patients underwent LND and from December 2010 to 2014, 250 patients had SLN mapping with completion LND. Interventions Pelvic lymph node dissection (LND) versus sentinel lymph node sampling (SLN) followed by LND. Measurements and Main Results During a median follow-up period of 6.9 years, addition of SLN was associated with more favorable oncological outcomes compared to LND with 6-year overall survival (OS) of 90% compared to 81% (p=0.009), and progression free survival (PFS) of 85% compared to 75% (p=0.01) respectively. SLN was associated with improved OS (HR 0.5, 95% CI 0.3-0.8, p=0.004), and PFS (HR 0.6, 95% CI 0.4-0.9, p=0.03) in a multivariable analysis, adjusted for age, ASA score, stage, grade, non-endometrioid histology, and LVSI. Patients who were staged with SLN were less likely to have a recurrence in the pelvis or lymph node basins compared to patients who underwent LND only (6-year recurrence-free survival 95% vs 90%, p=0.04). Conclusion Addition of SLN to LND was ultimately associated with improved clinical outcomes compared to LND alone in patients with endometrial cancer undergoing surgical staging, suggesting that the data provided by the analysis of the SLN added relevant clinical information, and improved the decision on adjuvant therapy.