title: Call for Surgical Nodal Staging in Women with ESMO/ESGO/ESTRO High-Intermediate Risk Endometrial Cancer: A Multicentre Cohort Analysis from the FRANCOGYN Study Group.
abstract: BACKGROUND
  The European Society of Medical Oncology (ESMO)/European Society of Gynaecological Oncology (ESGO)/European Society for Radiotherapy & Oncology (ESTRO) classification for endometrial cancer (EC) now includes a high-intermediate risk (HIR) group of recurrence due to the adverse prognostic role of lymphovascular space involvement (LVSI) and grade 3 for women at intermediate risk. However, optimal surgical staging, and especially the place of lymphadenectomy, remains to be elucidated. We aimed to establish whether systematic nodal staging should be part of surgical staging for women with HIR EC.
  
  
  METHODS
  We abstracted from a prospectively maintained multicentre database the data of 181 women with HIR EC based on uterine factors (endometrioid type 1, grade 1-2 tumors with deep (≥50%) myometrial invasion and unequivocally positive LVSI, and those with grade 3 tumors with <50% myometrial invasion regardless of LVSI status), who received primary surgical treatment between January 2001 and December 2013. We recorded frequency of lymph node (LN) metastases in those who underwent nodal staging. The secondary outcomes were overall survival and recurrence patterns.
  
  
  RESULTS
  Overall, 145 (80.1%) women underwent nodal staging consisting of at least pelvic lymphadenectomy. Of these, 62 (42.7%) had LN disease (9.7% with micrometastases). The respective 5-year overall survival rates according to LN status were 85.0% (95% confidence interval [CI] 76.5-91.4), 71.8% (95% CI 61.9-80.4) and 36.0% (95% CI 26.6-46.2) for women with negative LN, positive LN, and unstaged (p = 0.047). Unstaged women were more likely to experience nodal recurrence than surgically staged/LN negative women (p = 0.05).
  
  
  CONCLUSIONS
  Systematic nodal staging should be part of surgical staging for women with apparent ESMO/ESGO/ESTRO HIR EC. Sentinel LN biopsy (SLNB) could be an option in this specific setting that may possibly substitute comprehensive staging, for the identification of patients with lymphatic dissemination.
authors.affiliation: Department of Gynecology, Centre Hospitalier Universitaire de Tours, Tours, France. l.ouldamer@chu-tours.fr.|INSERM U1069, Université François-Rabelais, Tours, France. l.ouldamer@chu-tours.fr.
authors.forename: L
authors.initials: L
authors.lastname: Ouldamer
authors.affiliation: Department of Obstetrics and Gynaecology, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, GRC-6 UPMC, Université Pierre et Marie Curie, Paris, France.|UMR S 707, Epidemiology, Information Systems, Modeling, Université Pierre et Marie Curie, Paris, France.
authors.forename: S
authors.initials: S
authors.lastname: Bendifallah
authors.affiliation: Department of Gynecology, Centre Hospitalier Universitaire de Tours, Tours, France.|INSERM U1069, Université François-Rabelais, Tours, France.
authors.forename: G
authors.initials: G
authors.lastname: Body
authors.affiliation: Department of Obstetrics and Gynaecology, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, GRC-6 UPMC, Université Pierre et Marie Curie, Paris, France.|INSERM UMR S 938, Université Pierre et Marie Curie, Paris, France.
authors.forename: G
authors.initials: G
authors.lastname: Canlorbe
authors.affiliation: Department of Obstetrics and Gynaecology, Centre Hospitalier Intercommunal, Créteil, France.
authors.forename: C
authors.initials: C
authors.lastname: Touboul
authors.affiliation: Department of Obstetrics and Gynaecology, Institute Alix de Champagne University Hospital, Reims, France.
authors.forename: O
authors.initials: O
authors.lastname: Graesslin
authors.affiliation: Department of Obstetrics and Gynaecology, Institute Alix de Champagne University Hospital, Reims, France.
authors.forename: E
authors.initials: E
authors.lastname: Raimond
authors.affiliation: Department of Gynecological Surgery, Jeanne de Flandre University Hospital, Lille, France.
authors.forename: P
authors.initials: P
authors.lastname: Collinet
authors.affiliation: Centre de lutte contre le cancer Georges François Leclerc, Dijoin, France.
authors.forename: C
authors.initials: C
authors.lastname: Coutant
authors.affiliation: Departement of Gynecological Surgery, Rennes University Hospital, Rennes, France.
authors.forename: V
authors.initials: V
authors.lastname: Lavoué
authors.affiliation: Departement of Gynecological Surgery, Rennes University Hospital, Rennes, France.
authors.forename: J
authors.initials: J
authors.lastname: Lévêque
authors.affiliation: Department of Obstetrics and Gynaecology, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, GRC-6 UPMC, Université Pierre et Marie Curie, Paris, France.|INSERM UMR S 938, Université Pierre et Marie Curie, Paris, France.
authors.forename: E
authors.initials: E
authors.lastname: Daraï
authors.affiliation: Department of Obstetrics and Gynaecology, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, GRC-6 UPMC, Université Pierre et Marie Curie, Paris, France.|INSERM UMR S 938, Université Pierre et Marie Curie, Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Ballester
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016889:Endometrial Neoplasms / Q000473:pathology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008495:Medical Oncology; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000473:pathology* / Q000601:surgery; D009367:Neoplasm Staging; D011446:Prospective Studies; D012307:Risk Factors; D021701:Sentinel Lymph Node Biopsy; D012955:Societies, Medical; D015996:Survival Rate