Role of lymphadenectomy for apparent early stage uterine sarcoma; a comprehensive analysis of the National Cancer Database.

Autor: Nasioudis D; Division of Gynecologic Oncology, University of Pennsylvania Health System, Philadelphia, PA, USA. Electronic address: dimitrios.nasioudis@uphs.upenn.edu., Mastroyannis SA; Division of Gynecologic Oncology, University of Pennsylvania Health System, Philadelphia, PA, USA., Latif NA; Division of Gynecologic Oncology, University of Pennsylvania Health System, Philadelphia, PA, USA., Ko EM; Division of Gynecologic Oncology, University of Pennsylvania Health System, Philadelphia, PA, USA., Haggerty AF; Division of Gynecologic Oncology, University of Pennsylvania Health System, Philadelphia, PA, USA., Kim SH; Division of Gynecologic Oncology, University of Pennsylvania Health System, Philadelphia, PA, USA., Morgan MA; Division of Gynecologic Oncology, University of Pennsylvania Health System, Philadelphia, PA, USA., Giuntoli RL 2nd; Division of Gynecologic Oncology, University of Pennsylvania Health System, Philadelphia, PA, USA.
Jazyk: angličtina
Zdroj: Surgical oncology [Surg Oncol] 2021 Sep; Vol. 38, pp. 101589. Date of Electronic Publication: 2021 Apr 24.
DOI: 10.1016/j.suronc.2021.101589
Abstrakt: Objective: Investigate the role of lymphadenectomy for patients with apparent stage I uterine sarcoma.
Methods: The National Cancer Database was accessed and patients without a history of another tumor diagnosed between 2004 and 2015 with an apparent early stage leiomyosarcoma, adenosarcoma, low-grade endometrial stromal and high-grade endometrial stromal/undifferentiated sarcoma who underwent hysterectomy with or without lymphadenectomy were identified. Overall survival was assessed after stratification by histology with the log-rank test while Cox models were constructed to control for confounders.
Results: A total of 6412 patients with apparent early stage uterine sarcoma who underwent hysterectomy were identified; 2820 (44%) underwent lymphadenectomy. Rate of lymph node metastasis was 3.4% (42/1250) for patients with leiomyosarcoma, 2.3% (19/826) for those with adenosarcoma, 4.5% (21/463) for patients with low-grade endometrial stromal sarcoma and 7.9% (22/280) for those with high-grade endometrial stromal/undifferentiated sarcoma, p < 0.001. After controlling for confounders lymphadenectomy was not associated with better survival for patients with adenosarcoma (HR: 0.92, 95% CI: 0.73, 1.17), or low-grade endometrial stromal sarcoma (HR: 1.17, 95% CI: 0.73, 1.87). Patients with leiomyosarcoma who underwent lymphadenectomy had worse survival (HR: 1.15, 95% CI: 1.03, 1.28). Patients with high-grade endometrial stromal/undifferentiated sarcoma who underwent lymphadenectomy had better survival (HR: 0.66, 95% CI: 0.48, 0.89).
Conclusions: Incidence of lymph node metastasis in apparent early stage uterine sarcoma is rare while the performance of lymphadenectomy was not associated with a clear survival benefit for all histologic subtypes except high-grade endometrial stromal/undifferentiated sarcoma.
(Copyright © 2021 Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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