Accuracy and Survival Outcomes after National Implementation of Sentinel Lymph Node Biopsy in Early Stage Endometrial Cancer

Background. Sentinel lymph node (SLN) biopsy has recently been accepted to evaluate nodal status in endometrial cancer at early stage, which is key to tailoring adjuvant treatments. Our aim was to evaluate the national implementation of SLN biopsy in terms of accuracy to detect nodal disease in a clinical setting and oncologic outcomes according to the volume of nodal disease. Patients and Methods. A total of 29 Spanish centers participated in this retrospective, multicenter registry including patients with endometrial adenocarcinoma at preoperative early stage who had undergone SLN biopsy between 2015 and 2021. Each center collected data regarding demographic, clinical, histologic, therapeutic, and survival characteristics. Results. A total of 892 patients were enrolled. After the surgery, 12.9% were suprastaged to FIGO 2009 stages III-IV and 108 patients (12.1%) had nodal involvement: 54.6% macrometastasis, 22.2% micrometastases, and 23.1% isolated tumor cells (ITC). Sensitivity of SLN biopsy was 93.7% and false negative rate was 6.2%. After a median follow up of 1.81 years, overall surivial and disease-free survival were significantly lower in patients who had macrometastases when compared with patients with negative nodes, micrometastases or ITC. Conclusions. In our nationwide cohort we obtained high sensitivity of SLN biopsy to detect nodal disease. The oncologic outcomes of patients with negative nodes and low-volume disease were similar after tailoring adjuvant treatments. In total, 22% of patients with macrometastasis and 50% of patients with micrometastasis were at low risk of nodal metastasis according to their preoperative risk factors, revealing the importance of SLN biopsy in the surgical management of patients with early stage EC

Marcadores moleculares de invasión en el cáncer de endometrio

RESUMEN: De todas las etapas de la progresión del cáncer de endometrio, la infiltración del miometrio, invasión y diseminación a distancia son las menos conocida y estudiadas. La relación entre la invasión miometrial profunda, la invasión linfovascular y la afectación ganglionar con el descenso de la supervivencia hace que la profundización en el estudio de los factores moleculares de invasión cobre vital importancia de cara al tratamiento y pronóstico de la enfermedad. La cadherina-E es una molécula de adhesión celular que se relaciona con un buen pronóstico en el cáncer de endometrio. Material y métodos: tomando 126 muestras de carcinoma endometrial se estudió la expresión mediante inmunohistoquímica de receptores hormonales (RE, RP), Ki67, cerB2, p53 y Cadherina-E. Se realizó un análisis de supervivencia y posteriormente se incluyeron los resultados en un modelo multivariable para identificar los factores pronósticos independientes en la enfermedad. Resultados: la sobreexpresión de Cadherina-E se asoció de manera estadísticamente significativa a un aumento de la supervivencia en la casi totalidad de las pacientes, exceptuando los tumores de tipo I. El análisis multivariable muestra que sólo la Cadherina-E y el estadio constituyen factores pronósticos independientes de la supervivencia en el cáncer de endometrio. Conclusiones: Cadherina-E es un factor pronóstico independiente de la supervivencia en el carcinoma de endometrio, independientemente de la histología tumoral. La proliferación, sin embargo, no juega un papel importante en cuanto a supervivencia se refiere, lo cual explica la paradoja de la asociación entre Cadherina-E y los marcadores de proliferación cerbB2, Ki67 y p53, sin que ésta modifique el poder pronóstico de la Cadherina-EABSTRACT: E-cadherin is a putative marker of good prognosis in endometrial cancer. Paradoxically, we found in a previous study that E-cadherin in significantly co-expressed in endometrial carcinoma with molecular markers of proliferation, usually associated with a worse prognosis in most tumours. Methods: the expression of oestrogen and progesterone receptors (ER & PR), Ki67, c-erb-B2 p53 and E-cadherin was studied by means of immunohistochemistry in 126 endometrial carcinoma samples. The results were correlated with patient survival and included into a multivariate model, in order to identify those independently associate with the patient outcome. Results: E-cadherin overexpression was associated with a significantly better overall survival in the whole group of endometrial carcinoma patients, as well as in the group of patients harbouring endometrioid tumours exclusively. In the restricted multivariate model, only tumour stage and E-cadherin expression retained their independent prognostic power, both for the whole group of tumours, as well as for the subgroup of endometrioid carcinomas. Conclusion: E-cadherin is an independent predictor of survival in endometrial carcinoma, regardless of the histological variety. Proliferation, on the other hand, does not seem to play a prominent role in this same context. This explains why E-cadherin retains its prognostic power, despite being significantly co-expressed with all tested molecular proliferation markers

Accuracy and survival outcomes after national implementation of sentinel lymph node biopsy in early stage endometrial cancer

Background Sentinel lymph node (SLN) biopsy has recently been accepted to evaluate nodal status in endometrial cancer at early stage, which is key to tailoring adjuvant treatments. Our aim was to evaluate the national implementation of SLN biopsy in terms of accuracy to detect nodal disease in a clinical setting and oncologic outcomes according to the volume of nodal disease. Patients and Methods A total of 29 Spanish centers participated in this retrospective, multicenter registry including patients with endometrial adenocarcinoma at preoperative early stage who had undergone SLN biopsy between 2015 and 2021. Each center collected data regarding demographic, clinical, histologic, therapeutic, and survival characteristics. Results A total of 892 patients were enrolled. After the surgery, 12.9% were suprastaged to FIGO 2009 stages III-IV and 108 patients (12.1%) had nodal involvement: 54.6% macrometastasis, 22.2% micrometastases, and 23.1% isolated tumor cells (ITC). Sensitivity of SLN biopsy was 93.7% and false negative rate was 6.2%. After a median follow up of 1.81 years, overall surivial and disease-free survival were significantly lower in patients who had macrometastases when compared with patients with negative nodes, micrometastases or ITC. Conclusions In our nationwide cohort we obtained high sensitivity of SLN biopsy to detect nodal disease. The oncologic outcomes of patients with negative nodes and low-volume disease were similar after tailoring adjuvant treatments. In total, 22% of patients with macrometastasis and 50% of patients with micrometastasis were at low risk of nodal metastasis according to their preoperative risk factors, revealing the importance of SLN biopsy in the surgical management of patients with early stage EC.FUNDING. Open Access Funding provided by Universitat Autonoma de Barcelon