Call for Surgical Nodal Staging in Women with ESMO/ESGO/ESTRO High-Intermediate Risk Endometrial Cancer: A Multicentre Cohort Analysis from the FRANCOGYN Study Group

Lobna Ouldamer (1, 2) , S. Bendifallah (3, 4, 5) , G. Body (2, 1) , G. Canlorbe (4, 5, 6) , C. Touboul , O. Graesslin (7) , E. Raimond (7) , P. Collinet (8) , C. Coutant (9) , V. Lavoue (10, 11) , Jérémy Lévêque (11) , E. Darai (4, 5, 6) , M. Ballester (4, 12, 6)

1 N2Cox - Niche, Nutrition, Cancer et métabolisme oxydatif
2 CHU Trousseau [Tours]
3 Epidemiologie, Systèmes d'information, Modélisation
4 CHU Tenon [AP-HP]
5 GRC 6 - C3E - Groupe de recherche clinique Centre Expert en Endométriose
6 Pathologies biliaires, fibrose et cancer du foie
7 Institut Mère Enfant Alix de Champagne
8 Hôpital Jeanne de Flandres
9 UNICANCER/CRLCC-CGFL - Centre Régional de Lutte contre le cancer Georges-François Leclerc [Dijon]
10 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Ponchaillou]
11 OSS - Oncogenesis Stress Signaling
12 UMRS893 - Centre de Recherche Saint-Antoine

Background - The European Society of Medical Oncology (ESMO)/European Society of Gynaecological Oncology (ESGO)/European Society for Radiotherapy & Oncology (ESTRO) classification for endometrial cancer (EC) now includes a high-intermediate risk (HIR) group of recurrence due to the adverse prognostic role of lymphovascular space involvement (LVSI) and grade 3 for women at intermediate risk. However, optimal surgical staging, and especially the place of lymphadenectomy, remains to be elucidated. We aimed to establish whether systematic nodal staging should be part of surgical staging for women with HIR EC. Methods - We abstracted from a prospectively maintained multicentre database the data of 181 women with HIR EC based on uterine factors (endometrioid type 1, grade 1-2 tumors with deep (≥50%) myometrial invasion and unequivocally positive LVSI, and those with grade 3 tumors with <50% myometrial invasion regardless of LVSI status), who received primary surgical treatment between January 2001 and December 2013. We recorded frequency of lymph node (LN) metastases in those who underwent nodal staging. The secondary outcomes were overall survival and recurrence patterns. Results - Overall, 145 (80.1%) women underwent nodal staging consisting of at least pelvic lymphadenectomy. Of these, 62 (42.7%) had LN disease (9.7% with micrometastases). The respective 5-year overall survival rates according to LN status were 85.0% (95% confidence interval [CI] 76.5-91.4), 71.8% (95% CI 61.9-80.4) and 36.0% (95% CI 26.6-46.2) for women with negative LN, positive LN, and unstaged (p = 0.047). Unstaged women were more likely to experience nodal recurrence than surgically staged/LN negative women (p = 0.05). Conclusions - Systematic nodal staging should be part of surgical staging for women with apparent ESMO/ESGO/ESTRO HIR EC. Sentinel LN biopsy (SLNB) could be an option in this specific setting that may possibly substitute comprehensive staging, for the identification of patients with lymphatic dissemination.

Domaines: Cancer; Chimie thérapeutique

Lobna Ouldamer, S. Bendifallah, G. Body, G. Canlorbe, C. Touboul, et al.. Call for Surgical Nodal Staging in Women with ESMO/ESGO/ESTRO High-Intermediate Risk Endometrial Cancer: A Multicentre Cohort Analysis from the FRANCOGYN Study Group. Annals of Surgical Oncology, 2017, 24 (6), pp.1660--1666. ⟨10.1245/s10434-016-5731-0⟩. ⟨hal-01543368⟩