Systematic lymph node dissection (LND) does not provide a survival advantage over sentinel lymph node (SLN) biopsy for patients with uterine carcinosarcoma (CS), according to research published in Gynecologic Oncology.
The study showed no significant difference in progression-free survival (PFS) or overall survival (OS) between patients who underwent SLN biopsy alone and those who underwent systematic LND.
Researchers conducted this retrospective study to compare outcomes with the 2 methods in patients with uterine CS.
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A total of 199 patients with newly diagnosed uterine CS who underwent primary surgical management from January 1996 to December 2019 were identified. Of these patients, 99 had SLN mapping alone, and 100 patients underwent systematic LND.
The 2 cohorts were similar with regard to median age, median body mass index, stage distribution, depth of myometrial invasion, lymphovascular space invasion, rate of positive peritoneal washings, and lymph node positivity rate.
Approximately 86% of patients in the SLN cohort and 15% in the LND cohort underwent minimally invasive surgery (P <.001). The median total node count was 4 (range, 1 to 13) in the SLN cohort and 19 (range, 2 to 50) in the LND cohort (P <.001).
Researchers noted nodal metastasis in 23.2% of patients in the SLN cohort and 22% in the LND cohort (P =.4). Chemotherapy with or without radiotherapy was administered to a larger proportion of patients in the SLN cohort (85.9%) than in the LND cohort (71%; P =.02).
The recurrence rate was 44% overall, and recurrence rates were not significantly different between the 2 cohorts (P =.26). The median time to recurrence was 11 months in the SLN cohort and 12 months in the LND cohort. An isolated nodal recurrence was noted in 2 patients in the SLN cohort and 4 patients in the LND cohort (P =.26).
The median follow-up was 33 months in the SLN cohort and 55.3 months in the LND cohort (P =.001).
The 3-year PFS rate was 62.9% in the SLN cohort and 52.3% in the LND cohort (P =.13). The 3-year OS rate was 72.1% and 71.6%, respectively (P =.68).
There was no significant difference in PFS or OS between the 2 cohorts after adjusting for patient age or the type of postoperative therapy received.
Based on these results, the researchers concluded that SLN biopsy alone is feasible in patients with uterine CS.
“SLN biopsy should be considered part of standard surgical management of this disease,” they wrote. “Systematic LND does not seem to offer a survival advantage for patients with CS, and routine systematic LND of non-bulky nodes is likely unnecessary.”
Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Reference
Zammarrelli WA, Greenman M, Rios-Doria E, et al. Sentinel lymph node biopsy alone compared to systematic lymphadenectomy in patients with uterine carcinosarcoma. Gynecol Oncol. Published online February 26, 2022. doi:10.1016/j.ygyno.2022.02.012
