No Difference in Survival Observed in Uterine Carcinosarcoma Following SLN Biopsy vs Systemic LND

Investigators did not identify a difference in progression-free survival (PFS) or overall survival (OS) among patients with uterine carcinosarcoma who underwent sentinel lymph node (SLN) biopsy vs systemic lymph node dissection (LND), although utilization of SLN biopsy did not compromising outcomes.

Notably, the 3-year PFS rates were 62.9% in the SLN arm compared with 52.3% in the LND arm (P = .013). The 3-year OS rates were 72.1% vs 71.6% in both arms, respectively.

“SLN biopsy alone is feasible in patients with [uterine carcinosarcoma], adequately detects the presence of nodal metastasis, and does not compromise oncologic outcomes. SLN biopsy should be considered part of standard surgical management of this disease. Systematic LND does not seem to offer a survival advantage for patients with [uterine carcinosarcoma], and routine systematic LND of non-bulky nodes is likely unnecessary,” the investigators wrote.

The retrospective study included patients with uterine carcinosarcoma who received primary surgical staging from January 1996 to December 2019 and underwent either SLN biopsy or systemic LND. A total of 199 patients were identified, of whom 99 underwent SLN mapping alone and 100 received systematic LND.

The median patient age was 65 years and 66 years in the SLN and LND cohorts, respectively. Numerous characteristics between the 2 groups were balanced, with no differences noted for body mass index, stage distribution, depth of myometrial invasion, presence of lymphovascular space invasion, rate of positive peritoneal washings, and lymph node positivity rate. The median total node count was 4 in the SLN arm and 19 in the LND arm.

Moreover, 85.9% of patients in the SLN arm and 71% in the LND arm received postoperative chemotherapy with or without radiotherapy (P = .02). Post-operative regimens administered in the SLN and LND arms, respectively, included no post-operative therapy (14.1% vs 29.0%) and chemotherapy with or without radiotherapy (85.9% vs 71.0%). The most common chemotherapy regimens in both respective groups were carboplatin and paclitaxel (81%) and ifosfamide-based regimens (12%).

The study had a median follow up time of 33 months in the SLN group and 55.3 months in the LND group. Between the 2 groups, disease recurrence was observed in 44% of patients (P = .26). The median time to recurrence in the SLN and LND groups, respectively, was 11 months and 12 months. Additionally, isolated nodal occurrence was observed in 2% and 4% of patients, respectively (P = .26). Forty-three percent of patients died by the time of the univariate analysis.

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. 2022;165(2):P287-292. doi:10.1016/j.ygyno.2022.02.012