J Gynecol Oncol.
2021 Mar;32(2):e25. 10.3802/jgo.2021.32.e25.
Lymphadenectomy issues in endometrial cancer
- Konno Y
1 - Asano H1
- Shikama A2
- Aoki D3
- Tanikawa M4
- Oki A5
- Horie K6
- Mitsuhashi A7
- Kikuchi A8
- Tokunaga H9
- Terao Y10
- Satoh T2
- Ushijima K11
- Ishikawa M12
- Yaegashi N9
- Watari H1
- Affiliations
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- 1Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine and Faculty of Medicine, Sapporo, Japan
- 2Department of Obstetrics and Gynecology, University of Tsukuba, Faculty of Medicine, Tsukuba, Japan
- 3Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
- 4Department of Obstetrics and Gynecology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- 5Department of Obstetrics and Gynecology, Ibaraki Prefectural Central Hospital, Kasama, Japan
- 6Department of Gynecology, Saitama Cancer Center, Saitama, Japan
- 7Department of Reproductive Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan
- 8Department of Gynecology, Niigata Cancer Center Hospital, Niigata, Japan
- 9Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Japan
- 10Department of Obstetrics and Gynecology, Faculty of Medicine, Juntendo University, Tokyo, Japan
- 11Department of Obstetrics and Gynecology, Kurume University School of Medicine, Kurume, Japan
- 12Department of Gynecology, National Cancer Center Hospital, Tokyo, Japan
- KMID: 2526370
- DOI: http://doi.org/10.3802/jgo.2021.32.e25
Abstract
Objectives
This review aims to introduce preoperative scoring systems to predict lymph node metastasis (LNM) and ongoing clinical trials to investigate the therapeutic role of lymphadenectomy for endometrial cancer.
Methods
We summarized previous reports on the preoperative prediction models for LNM and evaluated their validity to omit lymphadenectomy in our recent cohorts. Next, we compared characteristics of two ongoing lymphadenectomy trials (JCOG1412, ECLAT) to examine the survival benefit of lymphadenectomy in endometrial cancer, and described the details of JCOG1412.
Results
Lymphadenectomy has been omitted for 64 endometrial cancer patients who met lowrisk criteria to omit lymphadenectomy using our scoring system (LNM score) and no lymphatic failure has been observed. Other two models also produced comparable results. Two randomized phase III trials to evaluate survival benefit of lymphadenectomy are ongoing for endometrial cancer. JCOG1412 compares pelvic lymphadenectomy alone with pelvic and para-aortic lymphadenectomy to evaluate the therapeutic role of para-aortic lymphadenectomy for patients at risk of LNM. For quality assurance of lymphadenectomy, we defined several regulations, including lower limit of the number of resected nodes, and submission of photos of dissected area to evaluate thoroughness of lymphadenectomy in the protocol. The latest monitoring report showed that the quality of lymphadenectomy has been well-controlled in JCOG1412.
Conclusion
Our strategy seems reasonable to omit lymphadenectomy and could be generalized in clinical practice. JCOG1412 is a high-quality lymphadenectomy trial in terms of the quality of surgical procedures, which would draw the bona-fide conclusions regarding the therapeutic role of lymphadenectomy for endometrial cancer.
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