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Clinical and Experimental Obstetrics & Gynecology  2021, Vol. 48 Issue (1): 151-159    DOI: 10.31083/j.ceog.2021.01.2168
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Lymphadenectomy and pelvic irradiation in high-risk endometrioid endometrial cancer: a population-based retrospective analysis using the SEER databank
Amr A Soliman1, †, *(), Meike Schild-Suhren1, †, Sayed A Mostafa2, Sarah Antar3, Ahmed Nezzal3, Basel Refky3, Onur Güralp1, Eduard Malik1
1University Women's Hospital, Klinikum Oldenburg, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany. Rahel-Straus-Straße 10, 26133 Oldenburg, Germany
2Statistics Department, Indiana University, Bloomington, 47405 IN, USA
3Oncology Center Mansura University, Department of Surgical Oncology, University of Mansura, 35516 Mansura, Egypt
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The current role of lymphadenectomy in early-stage high-risk endometrioid endometrial cancer is to guide further adjuvant treatment according to lymph node status. Whether the procedure has any therapeutic role remains controversial. In this study we aimed to investigate the outcome of current practices by performing a population-based retrospective cohort analysis using the US population-derived freely accessible public Surveillance, Epidemiology and End Results program (SEER) database. SEER data from patients with endometrial cancer treated between 2004 and 2012 were accessed online on March 1, 2016. Kaplan-Meier estimators were used to describe the survival distribution and the log-rank (Mantel-Cox) test was used to perform overall and pairwise comparisons of the survival distributions. The cohort included 47,463 patients, 10,288 of whom fulfilled high-risk criteria. A higher lymph node yield count was associated with better overall survival, although the removal of more than 40 lymph nodes did not confer any further survival benefit. The application of pelvic irradiation without lymph node status confirmation did not provide a survival benefit. From this analysis, no evidence of a survival benefit associated with lymphadenectomy was found. However, the current role lymphadenectomy as a staging and guiding tool for further adjuvant treatment was supported. Well-designed prospective randomized trials are required to conclusively determine the prognostic and therapeutic value of lymphadenectomy in patients with high-risk endometrioid endometrial cancers.
Key words:  Endometrial cancer      Lymphadenectomy      High-risk endometrioid endometrial cancer      Pelvic irradiation     
Submitted:  27 May 2020      Revised:  03 September 2020      Accepted:  04 September 2020      Published:  15 February 2021     
*Corresponding Author(s):  Amr A Soliman     E-mail:
About author:  These authors contributed equally.

Cite this article: 

Amr A Soliman, Meike Schild-Suhren, Sayed A Mostafa, Sarah Antar, Ahmed Nezzal, Basel Refky, Onur Güralp, Eduard Malik. Lymphadenectomy and pelvic irradiation in high-risk endometrioid endometrial cancer: a population-based retrospective analysis using the SEER databank. Clinical and Experimental Obstetrics & Gynecology, 2021, 48(1): 151-159.

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