Introduction
Endometrial cancer (EC) is the most frequent gynecologic cancer, and usually diagnosed in early-stages with a favorable prognosis1. The standard surgical treatment for EC includes of a total hysterectomy and bilateral salpingo-oophorectomy with or without lymph node dissection (LND). The uncertainty in LND still remains due to lack of data that demonstrates a survival benefit in randomized controlled trials (RCTs) 2,3, in addition to possible complications of the LND.
A great majority of EC cases are diagnosed at earl stages. However, there is large heterogeneity regarding the histopathology and the characteristics of patients affecting prognosis and the adjuvant treatment recommendations. Different risk of recurrence in a multidisciplinary evidence-based classification for clinical practice has been established by the European Society of Medical Oncology, European Society of Gynaecological Oncology, and European Society of Radiotherapy and Oncology (ESMO-ESGO-ESTRO) for managing the different subgroups of the disease 4. According to this guideline early-stage endometrial cancer classified into low, intermediate, high-intermediate or high-risk for recurrence.
By considering the benefit-to-harm ratio, guidelines recommend considering omission of LND for patients with low-risk early-stage EC5,6, and LND for high-risk EC is obviously prioritised as beneficial for survival 7. However, the importance of lymph node dissection (LND) remains unclear for EC identified in intermediate (IR) and high-intermediate (HIR) risk goups8. Although the roles of LND are guiding adjuvant treatment planning by assessing the extend of disease, and removing apparent or occult metastatic lymph nodes for a therapeutic utility9. Previous studies pointed out that LND in IR and HIR EC reduced the risk of pelvic recurrences, but overall survival (OS) benefit was not reported 10,11.
In the present study, in a cohort of EC patients, we aimed to evaluate the prognostic difference between EC patients with or without performing LND to reveal the necessity of LND in the management of IR and HIR.