Three-Year Recurrence-Free Survival in Patients with a Very Low Risk of Endometrial Cancer Who Did Not Undergo Lymph Node Dissection (Tree Retro)

A Korean Multicenter Study

Miseon Kim, Chelhun Choi, Kidong Kim, Myong Cheol Lim, Jeong Yeol Park, Jin-Hwa Hong, Maria Lee, Jiheum Paek, Jungyeob Seoung, Seungho Lee, Taek Sang Lee

Research output: Contribution to journalArticle

Abstract

Objective Randomized studies have not demonstrated a survival benefit of routine lymph node dissection in early-stage endometrial cancer. Many surgeons nevertheless perform lymph node dissection in all patients with early-stage endometrial cancer. This study aimed to ascertain the survival outcomes of very low-risk endometrial cancer patients (by the Korean Gynecologic Oncology Group [KGOG] criteria) who did not undergo lymph node dissection. Materials and Methods Medical records of 156 consecutive patients who underwent surgical staging without lymph node dissection were collected from 10 institutions. All patients fulfilled the KGOG criteria: (1) endometrioid corpus cancer diagnosed by preoperative endometrial biopsy, (2) serum cancer antigen-125 level ≤35 IU/mL, (3) <50% myometrial invasion with no extension beyond the uterine corpus by magnetic resonance imaging (MRI), and (4) no lymph nodes with a short diameter ≥1.0 cm by MRI or computed tomography. Sampling of <5 nodes was allowed at a surgeon's discretion. We evaluated the 3-year recurrence-free survival (RFS) and 5-year overall survival (OS) using the Kaplan-Meier method. Results The median patient age was 52 years (range, 24-86 years). The median follow-up was 59 months (range, 0-189 months). The 3-year RFS and 5-year OS were 98.6% (95% confidence interval [CI], 96.8%-100.0%) and 98.6% (95% CI, 96.7%-100.0%), respectively. No disease-related mortality occurred. The final pathology report revealed ≥50% myometrial invasion in 29 patients (18.6%) and extension beyond the uterine corpus in 2 patients (1.3%). One patient (0.6%) was diagnosed with lymph node metastasis after lymph node sampling. Eighteen patients (11.5%) received adjuvant therapy after the final pathologic results indicated high risk. Conclusions Very low-risk patients who did not undergo lymph node dissection had acceptable survival outcomes. Omitting lymph node dissection may be reasonable in patients satisfying the KGOG criteria.

Original languageEnglish
Pages (from-to)1123-1129
Number of pages7
JournalInternational Journal of Gynecological Cancer
Volume28
Issue number6
DOIs
Publication statusPublished - 2018 Jul 1

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Endometrial Neoplasms
Lymph Node Excision
Multicenter Studies
Recurrence
Survival
Lymph Nodes
Magnetic Resonance Imaging
Confidence Intervals
Medical Records
Neoplasms
Tomography
Pathology
Neoplasm Metastasis
Biopsy
Antigens
Mortality

Keywords

  • Endometrial cancer
  • Low risk
  • Lymph node dissection
  • Recurrence-free survival

ASJC Scopus subject areas

  • Oncology
  • Obstetrics and Gynaecology

Cite this

Three-Year Recurrence-Free Survival in Patients with a Very Low Risk of Endometrial Cancer Who Did Not Undergo Lymph Node Dissection (Tree Retro) : A Korean Multicenter Study. / Kim, Miseon; Choi, Chelhun; Kim, Kidong; Lim, Myong Cheol; Park, Jeong Yeol; Hong, Jin-Hwa; Lee, Maria; Paek, Jiheum; Seoung, Jungyeob; Lee, Seungho; Lee, Taek Sang.

In: International Journal of Gynecological Cancer, Vol. 28, No. 6, 01.07.2018, p. 1123-1129.

Research output: Contribution to journalArticle

Kim, Miseon ; Choi, Chelhun ; Kim, Kidong ; Lim, Myong Cheol ; Park, Jeong Yeol ; Hong, Jin-Hwa ; Lee, Maria ; Paek, Jiheum ; Seoung, Jungyeob ; Lee, Seungho ; Lee, Taek Sang. / Three-Year Recurrence-Free Survival in Patients with a Very Low Risk of Endometrial Cancer Who Did Not Undergo Lymph Node Dissection (Tree Retro) : A Korean Multicenter Study. In: International Journal of Gynecological Cancer. 2018 ; Vol. 28, No. 6. pp. 1123-1129.
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abstract = "Objective Randomized studies have not demonstrated a survival benefit of routine lymph node dissection in early-stage endometrial cancer. Many surgeons nevertheless perform lymph node dissection in all patients with early-stage endometrial cancer. This study aimed to ascertain the survival outcomes of very low-risk endometrial cancer patients (by the Korean Gynecologic Oncology Group [KGOG] criteria) who did not undergo lymph node dissection. Materials and Methods Medical records of 156 consecutive patients who underwent surgical staging without lymph node dissection were collected from 10 institutions. All patients fulfilled the KGOG criteria: (1) endometrioid corpus cancer diagnosed by preoperative endometrial biopsy, (2) serum cancer antigen-125 level ≤35 IU/mL, (3) <50{\%} myometrial invasion with no extension beyond the uterine corpus by magnetic resonance imaging (MRI), and (4) no lymph nodes with a short diameter ≥1.0 cm by MRI or computed tomography. Sampling of <5 nodes was allowed at a surgeon's discretion. We evaluated the 3-year recurrence-free survival (RFS) and 5-year overall survival (OS) using the Kaplan-Meier method. Results The median patient age was 52 years (range, 24-86 years). The median follow-up was 59 months (range, 0-189 months). The 3-year RFS and 5-year OS were 98.6{\%} (95{\%} confidence interval [CI], 96.8{\%}-100.0{\%}) and 98.6{\%} (95{\%} CI, 96.7{\%}-100.0{\%}), respectively. No disease-related mortality occurred. The final pathology report revealed ≥50{\%} myometrial invasion in 29 patients (18.6{\%}) and extension beyond the uterine corpus in 2 patients (1.3{\%}). One patient (0.6{\%}) was diagnosed with lymph node metastasis after lymph node sampling. Eighteen patients (11.5{\%}) received adjuvant therapy after the final pathologic results indicated high risk. Conclusions Very low-risk patients who did not undergo lymph node dissection had acceptable survival outcomes. Omitting lymph node dissection may be reasonable in patients satisfying the KGOG criteria.",
keywords = "Endometrial cancer, Low risk, Lymph node dissection, Recurrence-free survival",
author = "Miseon Kim and Chelhun Choi and Kidong Kim and Lim, {Myong Cheol} and Park, {Jeong Yeol} and Jin-Hwa Hong and Maria Lee and Jiheum Paek and Jungyeob Seoung and Seungho Lee and Lee, {Taek Sang}",
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T2 - A Korean Multicenter Study

AU - Kim, Miseon

AU - Choi, Chelhun

AU - Kim, Kidong

AU - Lim, Myong Cheol

AU - Park, Jeong Yeol

AU - Hong, Jin-Hwa

AU - Lee, Maria

AU - Paek, Jiheum

AU - Seoung, Jungyeob

AU - Lee, Seungho

AU - Lee, Taek Sang

PY - 2018/7/1

Y1 - 2018/7/1

N2 - Objective Randomized studies have not demonstrated a survival benefit of routine lymph node dissection in early-stage endometrial cancer. Many surgeons nevertheless perform lymph node dissection in all patients with early-stage endometrial cancer. This study aimed to ascertain the survival outcomes of very low-risk endometrial cancer patients (by the Korean Gynecologic Oncology Group [KGOG] criteria) who did not undergo lymph node dissection. Materials and Methods Medical records of 156 consecutive patients who underwent surgical staging without lymph node dissection were collected from 10 institutions. All patients fulfilled the KGOG criteria: (1) endometrioid corpus cancer diagnosed by preoperative endometrial biopsy, (2) serum cancer antigen-125 level ≤35 IU/mL, (3) <50% myometrial invasion with no extension beyond the uterine corpus by magnetic resonance imaging (MRI), and (4) no lymph nodes with a short diameter ≥1.0 cm by MRI or computed tomography. Sampling of <5 nodes was allowed at a surgeon's discretion. We evaluated the 3-year recurrence-free survival (RFS) and 5-year overall survival (OS) using the Kaplan-Meier method. Results The median patient age was 52 years (range, 24-86 years). The median follow-up was 59 months (range, 0-189 months). The 3-year RFS and 5-year OS were 98.6% (95% confidence interval [CI], 96.8%-100.0%) and 98.6% (95% CI, 96.7%-100.0%), respectively. No disease-related mortality occurred. The final pathology report revealed ≥50% myometrial invasion in 29 patients (18.6%) and extension beyond the uterine corpus in 2 patients (1.3%). One patient (0.6%) was diagnosed with lymph node metastasis after lymph node sampling. Eighteen patients (11.5%) received adjuvant therapy after the final pathologic results indicated high risk. Conclusions Very low-risk patients who did not undergo lymph node dissection had acceptable survival outcomes. Omitting lymph node dissection may be reasonable in patients satisfying the KGOG criteria.

AB - Objective Randomized studies have not demonstrated a survival benefit of routine lymph node dissection in early-stage endometrial cancer. Many surgeons nevertheless perform lymph node dissection in all patients with early-stage endometrial cancer. This study aimed to ascertain the survival outcomes of very low-risk endometrial cancer patients (by the Korean Gynecologic Oncology Group [KGOG] criteria) who did not undergo lymph node dissection. Materials and Methods Medical records of 156 consecutive patients who underwent surgical staging without lymph node dissection were collected from 10 institutions. All patients fulfilled the KGOG criteria: (1) endometrioid corpus cancer diagnosed by preoperative endometrial biopsy, (2) serum cancer antigen-125 level ≤35 IU/mL, (3) <50% myometrial invasion with no extension beyond the uterine corpus by magnetic resonance imaging (MRI), and (4) no lymph nodes with a short diameter ≥1.0 cm by MRI or computed tomography. Sampling of <5 nodes was allowed at a surgeon's discretion. We evaluated the 3-year recurrence-free survival (RFS) and 5-year overall survival (OS) using the Kaplan-Meier method. Results The median patient age was 52 years (range, 24-86 years). The median follow-up was 59 months (range, 0-189 months). The 3-year RFS and 5-year OS were 98.6% (95% confidence interval [CI], 96.8%-100.0%) and 98.6% (95% CI, 96.7%-100.0%), respectively. No disease-related mortality occurred. The final pathology report revealed ≥50% myometrial invasion in 29 patients (18.6%) and extension beyond the uterine corpus in 2 patients (1.3%). One patient (0.6%) was diagnosed with lymph node metastasis after lymph node sampling. Eighteen patients (11.5%) received adjuvant therapy after the final pathologic results indicated high risk. Conclusions Very low-risk patients who did not undergo lymph node dissection had acceptable survival outcomes. Omitting lymph node dissection may be reasonable in patients satisfying the KGOG criteria.

KW - Endometrial cancer

KW - Low risk

KW - Lymph node dissection

KW - Recurrence-free survival

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