Survival In Early Stage Endometrial Cancer Not Improved By Pelvic Lymphadenectomy

Main Category: Cancer / Oncology
Also Included In: Women's Health / Gynecology;  Clinical Trials / Drug Trials
Article Date: 26 Nov 2008 - 2:00 PDT

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Systematic use of pelvic lymphadenectomy (removal of the lymph nodes) does not improve disease-free or overall survival in women with early-stage endometrial cancer, according to a randomized trial published online November 25 in the Journal of the National Cancer Institute.

The first site of metastasis for endometrial cancer is often the pelvic lymph nodes. However, few prospective studies have examined whether systematic removal of the pelvic lymph nodes improves patient outcomes.

To find out, Pierluigi Benedetti Panici, M.D., of the La Sapienza University in Rome and colleagues conducted a randomized controlled trial in which women with stage I endometrial cancer were assigned to have a standard hysterectomy and ovary removal with or without lymphadenectomy.

With a median follow-up of four years, there was no difference in patient outcomes between the two arms. Thirty-four (12.9 percent) of the 264 patients in the lymphadenectomy group and 33 (13.2 percent) of the 250 patients in the control group had disease recurrence. The median time to disease recurrence was 14 months in the lymphadenectomy arm and 13 months in the control arm. Overall five-year survival estimates were 86 percent for the lymphadenectomy arm and 90 percent for the non-lymphadenectomy.

Surgical staging of the disease was improved with the systematic use of lymphadenectomy. A total of 13.3 percent of the women in the lymphadenectomy arm were found to have disease spread to pelvic lymph nodes, compared with 3.2 percent of the women in the control arm. The investigators found that although lymphadenectomy was not statistically significantly associated with improved survival, disease spread to the nodes was associated with poorer survival.

"Therefore, lymph¬adenectomy maintained its importance in determining a patient's prognosis and in tailoring adjuvant therapies," the authors conclude.

In an accompanying editorial, Christine Walsh, M.D., and Beth Karlan, M.D., of the Cedars-Sinai Medical Center in Los Angeles note that these new data are consistent with the one other randomized trial that examined the impact of lymphadenectomy on survival.

"These results bust the myth that is based on previous retrospective studies that lymphadenectomy, in and of itself, provides therapeutic ben¬efit and survival advantage in endometrial cancer," the editorialists write. "Yet, this trial continues to support the notion that lymphadenectomy can provide important prognostic information and can help guide adjuvant treatment recommendations."

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Citation:

Article: Benedetti Panici P, et al. Systematic Pelvic Lymphadenectomy vs No Lymphadenectomy in Early-Stage Endometrial Carcinoma: Randomized Clinical Trial. Journal of the National Cancer Institute 2008; 100:1707-1716

Editorial: Walsh CS, Karlan BY. Lymphadenectomy's Role in Early Endometrial Cancer: Prognostic or Therapeutic? Journal of the National Cancer Institute 2008; 100:1660-1661

The Journal of the National Cancer Institute is published by Oxford University Press and is not affiliated with the National Cancer Institute. Visit the Journal online at http://jnci.oxfordjournals.org/.

Source: Liz Savage
Journal of the National Cancer Institute

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