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OS, disease-free survival unaffected by pelvic lymphadenectomy in endometrial carcinoma
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Pelvic lymphadenectomy did not improve OS and disease-free survival among patients with early-stage endometrial cancer, according to data from a randomized trial. However, lymphadenectomy did improve surgical staging.
Researchers conducted a clinical trial to determine the efficacy of pelvic lymphadenectomy when added to standard hysterectomy with bilateral salpingo-oophorectomy for the treatment of stage I endometrial carcinoma.
From Oct. 1, 1996 to March 31, 2006, 514 patients were randomly assigned to pelvic systematic lymphadenectomy (n=264) or no lymphadenectomy (n=250). The researchers collected data for postoperative complications, adjuvant therapy and at follow-up six months post-surgery.
Thirty lymph nodes were removed in the lymphadenectomy group. Patients in this group experienced more early and late postoperative complications (n=81) compared with patients who did not undergo lymphadenectomy (n=34; P=.001).
More patients in the lymphadenectomy group were found to have metastases compared with those who did not undergo lymphadenectomy (13.3% vs. 3.2%; P<.001).
Median follow-up was 49 months, at which time 78 events (recurrence or death) had occurred and 53 patients had died. According to the researchers, the unadjusted risks for first event and death were similar between the two groups (HR for first event=1.10; 95% CI, 0.70-1.71 and HR for death=1.20; 95% CI, 0.70-2.07).
In an intention-to-treat analysis, five-year disease-free survival and OS rates were similar between the two groups (81% and 85.9% for lymphadenectomy and 81.7% and 90% for no lymphadenectomy).
“Although systematic lymphadenectomy statistically significantly improved surgical staging, it did not improve disease-free or overall survival,” the researchers wrote.
J Natl Cancer Inst. 2008;100:1707-1716.