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- Title
Survival implication of lymphadenectomy in patients surgically treated for apparent early-stage uterine serous carcinoma.
- Authors
Casarin, Jvan; Bogani, Giorgio; Piovano, Elisa; Falcone, Francesca; Ferrari, Federico; Odicino, Franco; Puppo, Andrea; Bonfiglio, Ferdinando; Donadello, Nicoletta; Pinelli, Ciro; Laganà, Antonio Simone; Ditto, Antonino; Malzoni, Mario; Greggi, Stefano; Raspagliesi, Francesco; Ghezzi, Fabio
- Abstract
Objective: Uterine serous carcinoma (USC) is a rare highly aggressive disease. In the present study, we aimed to investigate the survival implication of the systematic lymphadenectomy in patients who underwent surgery for apparent early-stage USC. Methods: Consecutive patients with apparent early-stage USC surgically treated at six Italian referral cancer centers were analyzed. A comparison was made between patients who underwent retroperitoneal staging including at least pelvic lymphadenectomy "LND" vs. those who underwent hysterectomy alone "NO-LND". Baseline, surgical and oncological outcomes were analyzed. Kaplan- Meier curves were calculated for disease-free survival (DFS) and disease-specific survival (DSS). Associations were evaluated with Cox proportional hazard regression and summarized using hazard ratio (HR). Results: One hundred forty patients were analyzed, 106 LND and 34 NO-LND. NO-LND group (compared to LND group) included older patients (median age, 73 vs.67 years) and with higher comorbidities (median Charlson Comorbidity Index, 6 vs. 5) (p<0.001). No differences in terms of recurrence rate (LND vs. NO-LND, 33.1% vs. 41.4%; p=0.240) were observed. At Cox regression analysis lymphadenectomy did not significantly influence DFS (HR=0.59; 95% confidence interval [CI]=0.32-1.08; p=0.09), and DSS (HR=0.14; 95% CI=0.02-1.21; multivariable analysis p=0.07). Positive node was independently associated with worse DFS (HR=6.22; 95% CI=3.08-12.60; p<0.001) and DSS (HR=5.51; 95% CI=2.31- 13.10; p<0.001), while adjuvant chemotherapy was associated with improved DFS (HR=0.38; 95% CI=0.17-0.86; p=0.02) and age was independently associated with worse DSS (HR=1.07; 95% CI=1.02-1.13; p<0.001). Conclusions: Although lymphadenectomy did not show survival benefits in patients who underwent surgery for apparent early-stage USC, the presence of lymph node metastasis was the main adverse prognostic factors, supporting the prognostic role of the retroperitoneal staging also in this histological subtype.
- Subjects
LYMPHADENECTOMY; OLDER patients; CARCINOMA; PROGRESSION-free survival; ADJUVANT treatment of cancer; REGRESSION analysis; RETROPERITONEUM diseases
- Publication
Journal of Gynecologic Oncology, 2020, Vol 31, Issue 5, p1
- ISSN
2005-0380
- Publication type
Article
- DOI
10.3802/jgo.2020.31.e64